A rare pulmonary zygomycosis manifested as chronic mediastinitis and bronchial perforation

To the Editors: Zygomycosis is an emerging infection caused by fungi of class Zygomycetes, order Mucorales. It occurs mostly in diabetic and immunocompromised patients, but occasionally occurs in immunocompetent individuals [1]. After rhinocerebral zygomycosis, pulmonary zygomycosis, which carries a high mortality rate, is the second most common presentation [1]. Common manifestations of pulmonary zygomycosis mainly include different types of pulmonary infiltrates [2], and other rare manifestations such as endobronchial mass lesions or mediastinitis. However, in the literature, bronchial perforation caused by zygomycetes has not been previously documented. This report presents the case of a diabetic patient infected with Rhizopus sp., which resulted in chronic mediastinitis and bronchial perforation. A 76-yr-old, Chinese, never-smoking female with uncontrolled type 2 diabetes experienced a productive cough for 6 months prior to admission. This patient denied having fever, breathlessness, night sweating or body weight loss. Physical examination revealed a moderately nourished female without respiratory distress or fever. Upon admission, laboratory studies revealed a haemoglobin level of 10.5 g·dL−1, white blood cell count 5.4×103 cells per μL (53.3% neutrophils, 28.3% lymphocytes, 6% monocytes and 12% eosinophils), platelet count 355×103 cells per μL, creatinine 0.9 mg·dL−1, C-reactive protein 1.7 mg·dL−1, fasting glucose level 311 mg·dL−1 and glycated haemoglobin 14.7%. The chest radiograph on admission revealed partial atelectasis of the …