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).