A 71-Year-Old Man With Chest Pain and a Solitary Pulmonary M
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A 71-year-old man was admitted to our hospital because of diffuse chest pain and a mass on routine chest radiography. He did not report cough, dyspnea, fever, night sweats, or weight loss. His medical history was remarkable for chronic lymphocytic leukemia diagnosed 13 years before presentation, and secondary myelodysplastic syndrome diagnosed 2 years before the onset of the current symptoms.

As a curative approach, he had received a matched unrelated stem cell transplantation 16 months earlier, and he had been in complete remission since. He developed chronic graft-vs-host disease, presenting mainly as oral ulceration which had been treated with oral cyclosporine and extracorporeal photopheresis. The immunosuppression had been tapered 6 months before presentation. Routine medication included co-trimoxazole prophylaxis twice per week. He had no known allergies, and he denied recent travels and sick contacts.

A molecular diagnostic test to identify fungal pathogens, ie, a universal, pan-fungal 18S ribosomal RNA PCR, followed by sequencing for genus and species identification was carried out which diagnosed Localized pulmonary mucormycosis caused by Rhizopus arrhizus. Because of the localized manifestation, surgical resection in toto was performed without complications. The antifungal treatment was preoperatively switched to IV liposomal amphotericin B. Intraoperatively, the mass appeared as a well-demarcated tumor. On discharge, the patient was started on oral posaconazole, which was stopped after 2 weeks. The patient remained asymptomatic during a follow-up of 10 months.

source: https://journal.chestnet.org/article/S0012-3692(20)30862-X/fulltext?rss=yes