Discussion
Here we reported a poorly controlled patient with diabetes mellitus and coexistence of lung Mucormycosis and hydatid cyst, which she was treated successfully with medical and surgical treatments. Based on imaging evidence and clinical findings, finally, the appropriate therapeutic response to treatment was observed. Best of our knowledge this is the first reported case of coexistence of pulmonary Mucormycosis and hydatid cyst.
In our reported case, the patient was taken to the operating room with diagnosis of hydatid cyst, which is an indication for thoracotomy, and the pathology finding was consistent with Mucormycosis. The most accurate diagnostic method for fungi infections is to perform a biopsy and observe vascular invasion and subsequent tissue thrombosis with evidence of acute and chronic inflammation in the sample. In our case the surgical biopsy was sent for pathologic assessments and 90-degree angle branching and non-parallel walls consistent with Mucormycosis was reported.
In patients with symptoms of pneumonia who do not respond to the treatment, Mucormycosis should be considered from a diagnostic perspective. The presence of this infection and the lack of a standard protocol for treatment is experimental for now (10). In general, dealing with patients with Mucormycosis includes natural treatment and elimination of the underlying factor. Because of underlying conditions, in the present case, amphotericin b consumption was started.
The prognosis of Mucormycosis depends on several factors, including rapid diagnosis recovery, and the underlying factor. Studies in this regard have also yielded favorable results from the administration of hyperbaric oxygen and liposomal nystatin. Liposomal amphotericin is the most effective drug known for the medical treatment of Mucormycosis. The duration and dose of the drug depend on various factors, including the side effects, patient tolerance, and the progress of the disease (11). The Survival rate is higher using the combination of medical and surgical treatment (12). Our patient was treated with liposomal amphotericin B and itraconazole 200mg as a maintenance therapy. According to the patient’s improvement in the treatment process and also other studies in this field, it turns out that it was an appropriate treatment (13).