A case of concomitant pulmonary tuberculosis and mucormycosis in an insulin-dependent diabetic patient

• Main Authors: Jiménez-Zarazúa O, Vélez-Ramírez LN, Alcocer-León M, Utrilla-Álvarez JD, Martínez-Rivera MA, Flores-Saldaña GA, Mondragón JD
• Format: Article
• Language: English
• Published: Elsevier 2019-08-01
• Series: Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
• Online Access: http://www.sciencedirect.com/science/article/pii/S2405579419300312

Conditions, where the patient's immune system is compromised are the main risk factor for mucormycosis. Approximately 23% of the world's population is estimated to have a latent Mycobacterium tuberculosis infection and more than 10 million new cases were estimated in 2017. Pulmonary mucormycosis and tuberculosis co-infections are very rare. We present the case of a 56-year-old insulin-dependent diabetic patient with a pulmonary mucormycosis and tuberculosis co-infection. While the patient did not suffer from ketoacidosis, she had poor glycemic control. A chest X-ray and a computed tomography showed nodular and cavitary lesions in both lungs. The patient was diagnosed through a biopsy of the bronchial mucosa and an RT-PCR for M. tuberculosis from bronchoalveolar lavage. The patient was treated with the recommended 4-drug regimen for TB (i.e. isoniazid, rifampin, pyrazinamide, and ethambutol); concurrently, amphotericin B deoxycholate was administered to treat the mucormycosis infection. Thirty days after initial hospital admission the patient underwent a lobectomy on the right lung. The case described here is only the sixth case reported in the literature of concomitant pulmonary tuberculosis and mucormycosis and the third case associated with a TB and mucormycosis co-infection involving an uncontrolled DM patient to survive. Keywords: Diabetes, Immunosuppression, Pulmonary mucormycosis, Tuberculosis