Pulmonary mucormycosis in a patient with uncontrolled type 2 diabetes mellitus: a detailed case report

Abstract Background Pulmonary mucormycosis is a rare, rapidly progressive angioinvasive fungal infection associated with high mortality, particularly in patients with uncontrolled diabetes mellitus and other predisposing conditions. Early diagnosis remains challenging because its clinical manifestations often resemble those of more common respiratory infections. Case presentation We report the case of a 45-year-old woman with poorly controlled type 2 diabetes mellitus, hypothyroidism, and β-thalassemia minor who presented with a five-week history of persistent cough that was initially attributed to a respiratory viral infection. Despite empirical antimicrobial therapy, her condition progressively deteriorated. Bronchoscopy revealed extensive adherent whitish endobronchial lesions and abundant purulent secretions. Histopathological examination demonstrated broad, ribbon-like, pauciseptate to aseptate hyphae with irregular branching, consistent with pulmonary mucormycosis. Antifungal therapy was administered sequentially with posaconazole, amphotericin B, and subsequently liposomal amphotericin B. Surgical intervention was not feasible because of extensive pulmonary involvement and rapid clinical deterioration. The patient developed progressive respiratory failure and died despite intensive supportive care. Conclusions This case highlights the diagnostic challenges of pulmonary mucormycosis in patients with uncontrolled diabetes and persistent respiratory symptoms. Rapid clinical and radiological progression in a high-risk patient should prompt consideration of invasive fungal infection. Timely bronchoscopy and histopathological evaluation may facilitate early diagnosis and appropriate management.