Prolonged bronchoscopic management after relief of severe necrotic tracheobronchial obstruction in disseminated mucormycosis: a case report
Year: 2026
Type: article
Study design: Case Report
Abstract: species. Despite initial treatment, extensive necrotic tracheobronchial obstruction progressed, with complete occlusion of the right middle lobe bronchus and multilevel obstruction of the left upper lobe and right lower lobe bronchi. Systemic antifungal therapy and repeated bronchoscopic interventions, including necrotic tissue debridement and local amphotericin B instillation were associated with progressive clearance of necrosis, restoration of airway patency, and improvement of pulmonary and cerebral disease. Bronchoscopic interventions were initially performed two to three times weekly, with local amphotericin B at 25-35 mg per session. As previously occluded bronchi reopened, access to additional affected bronchi expanded the treatment area, the dose increased to 45-50 mg per session to cover additional affected areas, while intervention frequency. decreased to weekly. Further improvement allowed reduction of the local dose to 20 mg per session and less frequent interventions. Systemic antifungal therapy was discontinued at Month 12, but intermittent bronchoscopic interventions, including local amphotericin B instillation, continued through Month 25 because of the severity of the preceding endobronchial disease, persistent bronchial narrowing, and impaired secretion clearance. No recurrent extensive necrotic obstruction was observed. This case suggests a potential adjunctive role for bronchoscopic amphotericin B in selected patients with severe necrotic tracheobronchial mucormycosis and illustrates the need for continued airway surveillance and secretion clearance after relief of obstruction.
Institutions: Karolinska University Hospital, Karolinska Institutet
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,200
OpenAlex ID: W7224085361