Bronchoscopic Amphotericin B Instillation for Treatment of Pulmonary Mucormycosis: A Case Report

Background: Pulmonary mucormycosis is a rare but aggressive fungal infection, typically seen in immunocompromised patients, especially those with uncontrolled diabetes mellitus.Early diagnosis and prompt antifungal therapy are essential for improved outcomes.Case presentation: We report a case of a 63-year-old male with uncontrolled diabetes who presented with a cough, fever, breathlessness, and weight loss.Initial sputum microscopy revealed broad aseptate hyphae, and fungal culture grew Mucor-Rhizopus species.An X-ray showed bilateral lesions.The patient was treated with intravenous (IV) liposomal amphotericin B for 21 days, followed by oral posaconazole, but showed very minimal clinical or radiological improvement.Bronchoscopic instillation of amphotericin B (50 mg) was performed weekly for 3 weeks, in addition to systemic therapy.Following local instillation, the patient showed marked clinical and radiological improvement.Repeat bronchoscopy confirmed healing with granulation tissue and reduced necrotic debris.Conclusion: Bronchoscopic instillation of amphotericin B may serve as an effective adjunctive strategy in cases of pulmonary mucormycosis with poor response to systemic therapy.This case underscores the importance of individualized management in such life-threatening infections.