Correct!
2. Begin antifungal therapy

The washings and the biopsies all show an organism consistent with mucormycosis. Mucormycosis rarely colonizes and has a high mortality rate. For this reason he was treated with inhaled and systemic amphotericin and micafungin. Despite the therapy his left lung atelectasis progressed (Figure 5).

Figure 5. Portable chest x-ray showing complete opacification of the left chest.

Bronchoscopy revealed complete occlusion of the left upper and lower lobes by the endobronchial lesions and endoscopic balloon dilatation was performed, however, the atelectasis persisted. Because of the life-threatening nature of the infection and its progression in this patient, a left pneumonectomy was performed (4,5). He was started on prophylactic posaconazole after surgery and made a slow recovery. He was doing well when last seen five months afterwards on clinic follow up.

References

  1. Helman RS, Habal R. Heatstroke. Medscape 2015. Available at: http://emedicine.medscape.com/article/166320-overview (accessed 6/13/16).
  2. Branson RD. Secretion management in the mechanically ventilated patient. Respir Care. 2007 Oct;52(10):1328-42. [PubMed]
  3. Mahajan VK, Catron PW, Huber GL. The value of fiberoptic bronchoscopy in the management of pulmonary collapse. Chest. 1978 Jun;73(6):817-20. [CrossRef] [PubMed]
  4. Karnak D, Avery RK, Gildea TR, Sahoo D, Mehta AC. Endobronchial fungal disease: an under-recognized entity. Respiration. 2007;74(1):88-104. [CrossRef] [PubMed]
  5. Vercillo MS, Liptay MJ, Seder CW. Early pneumonectomy for pulmonary mucormycosis. Ann Thorac Surg. 2015 Mar;99(3):e67-8. [CrossRef] [PubMed] 

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