When cough leads to infarction: systemic arterial embolism as a sentinel complication of insidious pulmonary mucormycosis in an immunocompetent patient

Pulmonary mucormycosis is a rapidly progressive and often fatal invasive fungal infection typically associated with immunocompromised states. However, its emergence in immunocompetent individuals is increasingly reported. This case describes an unusual presentation of pulmonary mucormycosis in an immunocompetent adult complicated by arterial embolism, a rare and life-threatening vascular manifestation. We report the case of an immunocompetent adult patient presenting with persistent respiratory symptoms and radiological abnormalities. Despite the absence of conventional risk factors, the diagnosis was challenging due to nonspecific clinical features. The clinical course was further complicated by the development of an arterial embolism. The pathogen was successfully identified through metagenomic next-generation sequencing (mNGS), highlighting the utility of molecular diagnostic platforms for early detection in atypical hosts. The patient’s management required a combination of targeted antifungal therapy and intervention for the vascular complication. This case underscores the shifting epidemiology of mucormycosis and the necessity of maintaining a high index of clinical suspicion even in patients without apparent immunodeficiency. It emphasizes the critical role of advanced diagnostic tools like mNGS in reducing delays in intervention for a disease with mortality rates exceeding 30%–50%. Further research is required to standardize diagnostic algorithms and management strategies for pulmonary mucormycosis in immunocompetent populations. Rare presentation: A severe case of pulmonary mucormycosis in a host with no traditional immunodeficiencies or risk factors. Vascular complication: Documentation of systemic arterial embolism, highlighting the aggressive angioinvasive nature of Mucorales. Diagnostic innovation: Demonstration of mNGS as a critical tool for rapid and accurate diagnosis in culture-negative or atypical cases. Clinical vigilance: Underscores the need for early suspicion of invasive fungal infections despite an apparently normal immune status.