CTICasesPulmonary Mucormycosis (Rhizomucor pusillus) in a Non-Immunocompromised Patient
Imaging findings
CT demonstrates dense consolidation in the right upper lobe with areas of potential internal lucency that could represent necrotic lung or a mycetoma within a cavity. The patient has severe underlying emphysema with extensive bilateral apical bullae. The consolidation is dense and somewhat mass-like, raising initial concern for a neoplastic process or bacterial pneumonia. The lung parenchyma otherwise shows significant emphysematous destruction.
Key takeaways
Mucormycosis (in this case Rhizomucor pusillus) can occur in patients who are not classically immunocompromised but who have risk factors including COPD, malnutrition, and overwhelming environmental exposure. This patient had massive inhalation exposure from pulling back a tarp covering moldy hay, and was cachectic with microcytic anemia indicating malnutrition. COPD is a recognized risk factor for mucormycosis. The presentation as dense upper lobe consolidation in an elderly smoker may mimic bacterial pneumonia or lung cancer, and the diagnosis requires culture or pathologic confirmation.
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