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.