Pulmonary mucormycosis in a young adult as a complication of a bronchopulmonary fistula

Pulmonary mucormycosis (PM) is a life-threatening opportunistic infection caused by fungi of the <i>Mucorales</i> order, including genera such as <i>Rhizopus</i>, <i>Absidia</i>, and <i>Mucor</i>. This condition predominantly affects immunocompromised individuals, with mortality rates exceeding 50 % in high-risk populations. We present the case of a 33-year-old female with a medical history of type 1 diabetes mellitus (poorly controlled) and hypothyroidism, who presented to the hospital with a 7-day history of productive cough (mucoid expectoration), chills, and myalgia. An unenhanced chest computed tomography (CT) scan revealed a pneumonic process with left basal consolidation, predominantly in the lower lobe. Empirical broad-spectrum antibiotic therapy was initiated; however, the patient exhibited clinical deterioration, prompting consultation with the thoracic surgery team. A left thoracotomy with wedge resection and histopathological biopsy was performed, confirming invasive pulmonary mucormycosis through visualization of broad, pauci-septate hyphae on microscopy. Following diagnosis, the infectious disease department initiated antifungal therapy with intravenous liposomal amphotericin B (5 mg/kg/day). The patient demonstrated marked clinical improvement over the subsequent two weeks, enabling discharge with plans for 6 weeks of continued antifungal treatment and glycemic optimization.