PMC7240283_01
Top left: Initial chest x-ray on presentation showing right sided opacities and sub-cutaneous air in the neck. Top right: Axial cut of chest CT showing mediastinal air. Bottom right: Axial cut of CT demonstrating bronchomediastinal fistulas with necrotizing pneumonia. Bottom right: Coronal cut of the chest CT further demonstrating necrotizing areas in the right main bronchus and necrotizing pneumonia.
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Chest CT was subsequently performed, revealing extensive right sided infiltration with probable erosion of the right mainstem bronchus, pulmonary emphysema in the right-sided airways, as well as right upper lobe (RUL) and right middle lobe (RML) infiltrates and centrilobular ground-glass nodules were also noted (Fig. 1).
Bronchoscopic view of the carina. Double lumen endobronchial tube seen inserted into the left mainstem bronchus. Significant necrotic tissue is seen with the bronchomediastinal fistula in the right mainstem bronchus.
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Broncheoalveolar lavage was obtained of the right lung as well as endobronchial biopsies of the right mainstem (Fig. 2).
Left: Biopsy specimen showing fungal hyphae consistent with mucormycosis. Right: Mucor growth on fungal medium.
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On hospital day 3, acid fast bacilli smear resulted as negative, bronchiolar alveolar lavage cultures grew rhizopus, candida (albicans or candida dubliniensis), and endobronchial biopsies revealed necrotic tissue with fungal hyphae suggestive of mucor species, as well as actinomyces (Fig. 3).