PMC8418048_01
Chest radiograph: Showing bilateral middle zone (left > right) perihilar opacities with possibility of consolidation or left perihilar mass along with prominent bronchovascular marking.
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An electrocardiograph was done, which showed normal sinus rhythm, and a portable bedside chest radiograph showed bilateral hilar prominence with a possibility of consolidation or a mass lesion (left > right), as shown in Fig. 1.
[A], [B] and [E] CECT Chest showing a well-defined area in the superior and anteromedial segments of left lower lobe comprising of peripheral consolidation, central ground glass opacities and areas of cavitation suggestive of pulmonary mucormycosis along with bilateral ground glass opacities in peripheral and basal segments of bilateral lower lobes. [C] and [D]: CECT paranasal sinuses with orbit shows soft tissue thickening of right and left maxillary sinuses, and destruction of right maxillary sinus medial wall along with blocked right osteomeatal complex without orbital involvement suggestive of Sino-Nasal mucormycosis.
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Subsequently, a Contrast-Enhanced Computed Tomography Angiography (CECT- Angio) of the chest was performed, which depicted findings consistent with Pulmonary Mucormycosis and bilateral ground-glass opacities in lower lobes without any evidence of pulmonary artery thrombosis, as shown in Fig. 2, and a normal transthoracic 2D-echo study. A CECT of paranasal sinuses and orbit was done, which showed findings of Sino-nasal mucormycosis, as shown in Fig. 2.
[A]: Fungal KOH showing aseptate broad fungal hyphae consistent with mucormycosis. [B] Showing magnified view of silver methenamine stain in which 1-6 fungal hyphae seen.
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On the sixteenth day, he experienced right nasal congestion with blackish crusting of the nasal septum, a nasal swab for 20% KOH mount was sent, which showed aseptate branched fungal hyphae consisting of mucormycosis, as shown in Fig. 3.