Simultaneous endobronchial and mediastinal mucormycosis in a patient with Diabetes Mellitus and SARS-CoV-2: A case report and literature review

Background: Mucormycosis can be lethal in people with immunocompromising conditions, especially Diabetes Mellitus. Correction of the underlying disorders, instant initiation of antifungal therapy, and surgical resection are the main components of treatment. Herin, we present the successful medical management of Mucormycosis in a patient with Diabetic Ketoacidosis and positive SARS-CoV-2 test who presented with a less seen condition: the simultaneity of mediastinal mass on one side and an endobronchial mass on the other. Case presentation: An 18-year-old male with a history of insulin-dependent DM from 4 years ago presented to our hospital with sudden onset dyspnea, chest pain, sore throat, hoarseness, cough, and sputum. Also, we detected unilateral swelling in the neck and multiple lymph nodes in the neck. Lung auscultation revealed bilateral generalized wheezing. Primary laboratory tests detected high blood sugar, metabolic acidosis, positive urine ketone, high ESR, positive CRP, and leukocytosis; his polymerase chain reaction (PCR) for SARS-CoV-2 was positive. Chest X-ray showed left upper lobe consolidation. Computed tomography scan (CT-scan) of the chest revealed a large collapse consolidation in the left lung, mild left side pleural effusion, mediastinal lymphadenopathy, and distention in the esophagus. With suspicion of malignancy, we performed flexible bronchoscopy and endobronchial Ultrasound (EBUS) which revealed a creamy tumoral lesion in the right main bronchus. The biopsy was consistent with Mucormycosis. We successfully treated Mucormycosis with Amphotericin-B liposomal. Conclusion: Mucormycosis can mimic the clinical characteristics of malignancy, and emphasize the importance of considering appropriate differential diagnoses because timely diagnosis and treatment is potentially life-saving in Mucormycosis.