Primary Pulmonary Mucormycosis:A Case Report And Retrospectively Analysis Of Eighty-two Cases Published In Mainland China

Objective:To improve the understanding of primary pulmonary mucormycosis.Methods:One case of primary pulmonary mucormycosis treated in the First Affiliated Hospital of Soochow University was reported.82 cases of primary pulmonary mucormycosis were retrieved from four Chinese Medical databases(http://med.wanfangdata.com.cn,http://edu.cqvip.com,http://www.edu.cnki.net and http://www.dayi100.com)and analyzed retrospectively.Results:The chief complaint of the primary pulmonary mucormycosis case treated in the First Affiliated Hospital of Soochow University was fatigue,and he was confirmed via thoracic surgery.A total of 218 articles on primary pulmonary mucormycosis were retrieved from the four databases,with 82 cases meeting the inclusion criteria.Among the 83 cases,there were 48(57.8%)males and 35(42.2%)females,aging from 4 months to 76 years old.60(72.3%)cases had underlying diseases,mainly including diabetes(n = 38,63.3%)and malignant hematological diseases(n = 9,15.0%).The main clinical symptoms included cough(n = 61,73.5%),fever(n = 40,48.2%),hemoptysis(n = 23;27.7%),chest tightness and dyspnea(n = 19,22.9%),and chest pain(n = 16,19.3%).The imaging features included consolidations(n = 33,44.0%),cavitary lesion(n = 23,30.7%),patchy shadows(n = 16,21.3%),mediastinal lymph node enlargement(n = 12,16%),pleural effusion(n = 12,16%)and nodules(n = 7,9.3%).Thirty-five(42.2%)cases were confirmed by bronchoscopy,16(19.3%)cases by percutaneous lung biopsy,20(24.1%)cases by operation and 12(14.4%)cases by autopsy.The shortest duration from the onset of symptoms to confirmation was 10 hours,and the longest was 20 years(median duration,268 days).As for treatment,among the rest 71 cases,38 cases(53.5%)were treated with antifungal medicine,29 cases(40.8%)were treated with surgery or surgery combined with antifungal medicine,14 cases died.Conclusion:Primary pulmonary mucormycosis can occur at any ages and is common in males,without specific clinical symptoms.Consolidation and patchy shadows are typical imaging features.Bronchoscopy,percutaneous lung biopsy and surgery are the effective means for the diagnosis of pulmonary mucormycosis.It can be acute,but chronic type occurs more often.Surgery combined with antifungal agents is suggested for single lobe lesion,otherwise,antifungal medication is the mainly choice for patients related to double lobes lesion or more.The main cause of death is massive hemoptysis,followed by diabetic ketoacidosiss.