Introduction
Mucormycosis is an uncommon and rapidly progressive invasive fungal
infection that can in case of lack of timely diagnosis and treatment,
lead to mortality. It is usually caused by members of the Mucoraceae
family of fungi, which its subgroups include Rhizopus, Mucor, and
Absidis. Mucormycosis is transmitted through the air (1). This fungus is
not normally pathogenic and only occurs when the patient has underlying
diseases such as immunodeficiency and diabetic ketoacidosis (2). Other
conditions of immunodeficiency and the use of drugs that weaken the
immune system are the other predisposing factors.
Pulmonary Mucormycosis is the second most common manifestation of
mucositis, after the Rhinocerebral form. The symptoms of this infection
include dyspnea, cough, chest pain, and hemoptysis. Vascular invasion
causes necrosis, cavitation, or hemoptysis. Lobar opacity, solitary
mass, nodular disease, cavity, or wedge-shaped infarcts may be seen on
chest X-rays (3, 4). The diagnosis of Mucormycosis is a medical
challenge and autopsy studies have shown that up to half of cases were
diagnosed only after death (5).
Hydatid cyst, caused by Echinococcus, is a cestode parasite of the
tapeworm variant. Humans are mostly affected by two species: granulosus
and multilocularis which cause two major types of the disease; cystic
echinococcosis and alveolar echinococcosis (6). Hydatid cyst is a
crucial health problem in endemic areas and the disease is characterized
by slow-growing cysts.
The lungs are the second most prevalent site of this infection after the
liver. Manifestations of pulmonary hydatid cyst vary depending on
whether the cyst is intact or ripped and their clinical manifestations
mostly depend on size and location. Unripped cysts have no specific
symptoms. Large cysts may cause signs of dry cough, pressure on adjacent
organs, and upper superior vena cava syndrome. Also, atelectasis may be
seen due to the compressive effect on the bronchi. Diagnosis of a cystic
mass in a person who has a history of contact with dogs and lives in
endemic areas strongly suggests a hydatid cyst (7, 8). The treatment
method for hydatid cyst of the lung is surgery and drug treatments are
used in cases where surgery is not possible for any reason (9).
Coexistence of pulmonary Mucormycosis and hydatid cyst is a rare
phenomenon and best of our knowledge this is the first-ever reported
case of coexistence of these two pathogens. Here we report the symptoms,
diagnosis, treatment and follow-up details of our presented case of
coexistence of pulmonary Mucormycosis and hydatid cyst in Imam Reza
Medical Research and Training hospital of Tabriz University of Medical
Science.