PMC10202401_01
(a) Chest radiograph (first spot) showing non-homogenous opacification of right mid-lower zone with air bronchogram and obscured right costophrenic angle and right hemidiaphragm s/o Lobar pneumonia. HRCT of the chest with mediastinal and lung windows (second to fourth spots) showing dense opacification of right lower lobe (white arrow) limited by horizontal fissure s/o lobar pneumonia with multiple irregular cavities within it (long black arrow). Patchy area of consolidation seen in right upper lobe on coronal image (curved black arrow). (b) KOH mount of bronchoalveolar lavage, with arrows showing broad non-septate hyphae, which gives presumptive evidence for mucormycosis. (c) Lactophenol cotton blue (LPCB) mount showing R. homothallicus with characteristic golden brown, globose zygospores with stellate spines and suspensor cells (100x).
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PMC10202401_01_acmi-5-526.v3-g001.jpg
F1
Chest X-ray revealed consolidation in the middle and lower zone of the right lung (Fig. 1a). High-resolution computed tomography (HRCT) chest performed on day 2 showed a large area of consolidation with bronchiectasis, fibrosis and secondary cavitary changes showing air-fluid levels in the right lower lobe with intra- and interlobular septal thickening with ground glass haze giving a crazy paving pattern in the right lower lobes and a few patchy areas of consolidation in the right upper and middle lobe with minimal right pleural effusion (Fig. 1a). KOH examination was performed, which showed broad aseptate fungal hyphae (Fig. 1b). The isolate was identified as R. homothallicus based on the characteristic golden-brown spiny zygospores and suspensor cells, along with broad, aseptate hyphae, seen on a lactophenol cotton blue (LPCB) mount (Fig. 1c).
Phylogenetic tree constructed using mega X. The reference strains are represented by red dots and the strain under study is represented by a green square.
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PMC10202401_01_acmi-5-526.v3-g002.jpg
F2
The evolutionary tree was prepared using the neighbour-joining method and evolutionary analysis was conducted using mega X (Fig. 2).