Abstract：
BACKGROUND: Recently, deaths due to mucormycosis in immunocompromised hosts have increased; however, the clinical and pathological features of mucormycosis are not fully understood, especially in view of the associated high mortality and rare incidence in immunocompetent patients.
METHODS: We have described a rare autopsy case of a 67-year-old Japanese man with chronic obstructive pulmonary disease who contracted mucormycosis. He had not been on any immunosuppressants, and his immune functions were intact. Since 3 days prior to admission to our hospital, he had experienced progressive dyspnea, productive cough, and fever. Chest computed tomography revealed pleural effusion in the left lower hemithorax and consolidation in the right lung field. Although he was administered with tazobactam-piperacillin hydrate (13.5 g/day), renal dysfunction occurred on the ninth disease day. Therefore, it was switched to cefepime (2 g/day). However, his general condition and lung-field abnormality worsened gradually. Cytological analysis of the sputum sample at admission mainly revealed sporangiophores and unicellular sporangioles, while repeated sputum culture yielded Cunninghamella species. Therefore, he was diagnosed with pulmonary mucormycosis. Liposomal amphotericin B (5 mg/kg/day) was initiated on the 28th disease day. However, chest radiography and electrocardiography detected cardiomegaly and atrial fibrillation, respectively, and he died on the 37th disease day. A postmortem examination revealed clusters of fungal hyphae within the arteries of the right pulmonary cavity wall, the subpericardial artery, intramyocardial capillary blood vessels, and the esophageal subserosa vein. Direct sequencing revealed that all fungal culture samples were positive for Cunninghamella bertholletiae.
CONCLUSIONS: Cunninghamella bertholletiae could rapidly progress from colonizing the bronchi to infecting the surrounding organs via vascular invasion even in immunocompetent patients.
METHODS: We have described a rare autopsy case of a 67-year-old Japanese man with chronic obstructive pulmonary disease who contracted mucormycosis. He had not been on any immunosuppressants, and his immune functions were intact. Since 3 days prior to admission to our hospital, he had experienced progressive dyspnea, productive cough, and fever. Chest computed tomography revealed pleural effusion in the left lower hemithorax and consolidation in the right lung field. Although he was administered with tazobactam-piperacillin hydrate (13.5 g/day), renal dysfunction occurred on the ninth disease day. Therefore, it was switched to cefepime (2 g/day). However, his general condition and lung-field abnormality worsened gradually. Cytological analysis of the sputum sample at admission mainly revealed sporangiophores and unicellular sporangioles, while repeated sputum culture yielded Cunninghamella species. Therefore, he was diagnosed with pulmonary mucormycosis. Liposomal amphotericin B (5 mg/kg/day) was initiated on the 28th disease day. However, chest radiography and electrocardiography detected cardiomegaly and atrial fibrillation, respectively, and he died on the 37th disease day. A postmortem examination revealed clusters of fungal hyphae within the arteries of the right pulmonary cavity wall, the subpericardial artery, intramyocardial capillary blood vessels, and the esophageal subserosa vein. Direct sequencing revealed that all fungal culture samples were positive for Cunninghamella bertholletiae.
CONCLUSIONS: Cunninghamella bertholletiae could rapidly progress from colonizing the bronchi to infecting the surrounding organs via vascular invasion even in immunocompetent patients.
摘要：
背景：最近，在免疫功能低下的宿主中，由于毛霉菌病导致的死亡有所增加；然而，毛霉菌病的临床和病理特征尚未完全了解，特别是考虑到相关的高死亡率和罕见的发病率在免疫功能正常的患者。
方法：我们描述了一例罕见的尸检病例，一例67岁的日本男性患有慢性阻塞性肺疾病，感染了毛霉菌病。他没有服用过任何免疫抑制剂,免疫功能完好无损.从入院前3天开始，他经历了进行性呼吸困难，生产性咳嗽,和发烧。胸部计算机断层扫描显示左下半胸有胸腔积液，右肺野实变。尽管他服用他唑巴坦-哌拉西林水合物（13.5克/天），肾功能障碍发生在疾病第9天.因此,改用头孢吡肟(2克/天).然而,他的一般状况和肺野异常逐渐恶化。入院时痰标本的细胞学分析主要显示孢子囊和单细胞孢子囊，而反复的痰培养产生了Cunninghamella物种。因此,他被诊断患有肺毛霉菌病。在第28个疾病日开始脂质体两性霉素B(5mg/kg/天)。然而,胸部X线和心电图检测到心脏肥大和心房颤动，分别,他死于疾病的第37天.尸检发现右肺腔壁动脉内有真菌菌丝簇，心包下动脉,心肌内毛细血管,和食管浆膜下静脉.直接测序显示，所有真菌培养样品对伯氏昆虫菌均呈阳性。
结论：即使在免疫功能正常的患者中，Cunninghamellabertholletia也可以从支气管定植迅速发展到通过血管侵袭感染周围器官。
方法：我们描述了一例罕见的尸检病例，一例67岁的日本男性患有慢性阻塞性肺疾病，感染了毛霉菌病。他没有服用过任何免疫抑制剂,免疫功能完好无损.从入院前3天开始，他经历了进行性呼吸困难，生产性咳嗽,和发烧。胸部计算机断层扫描显示左下半胸有胸腔积液，右肺野实变。尽管他服用他唑巴坦-哌拉西林水合物（13.5克/天），肾功能障碍发生在疾病第9天.因此,改用头孢吡肟(2克/天).然而,他的一般状况和肺野异常逐渐恶化。入院时痰标本的细胞学分析主要显示孢子囊和单细胞孢子囊，而反复的痰培养产生了Cunninghamella物种。因此,他被诊断患有肺毛霉菌病。在第28个疾病日开始脂质体两性霉素B(5mg/kg/天)。然而,胸部X线和心电图检测到心脏肥大和心房颤动，分别,他死于疾病的第37天.尸检发现右肺腔壁动脉内有真菌菌丝簇，心包下动脉,心肌内毛细血管,和食管浆膜下静脉.直接测序显示，所有真菌培养样品对伯氏昆虫菌均呈阳性。
结论：即使在免疫功能正常的患者中，Cunninghamellabertholletia也可以从支气管定植迅速发展到通过血管侵袭感染周围器官。
