Bronchial mucormycosis with progressive air trapping

A previously healthy 70-year-old woman developed fever, cough, and exertion al dyspnea. Her symptoms progressed over a 2-month period despite treatment by her primary care physician with 2 courses of oral antibiotics and the a ddition of prednisone. Hypoxemia and the finding of hyperglycemia with mild ketoacidosis led to hospital admission. Serial chest radiographs demonstra ted diffuse heterogeneous pulmonary opacities and progressive air trapping in the right lower lobe. Fiberoptic bronchoscopy revealed a deep penetratin g ulcer with exposed bronchial cartilage of the bronchus intermedius and dy namic airway obstruction with complete closure during expiration. Biopsy of the ulcer revealed Rhizopus arrhizus. Respiratory failure stabilized with the patient on conventional mechanical ventilation and receiving amphoteric in B. Before surgery could be performed, Pseudomonas aeruginosa pneumonia a nd septic shock developed, and the patient died.