Pulmonary tuberculosis and rhinosinus mucormycosis coinfection in a diabetic patient

Shiva Shabani; Payam Tabarsi; Golnaz Afzal

doi:10.18502/cmm.8.2.10332

Shiva Shabani Department of Infectious Diseases, School of Medicine, Arak University of Medical Sciences, Arak, Iran
Payam Tabarsi Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
Golnaz Afzal Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/cmm.8.2.10332

Keywords: Diabetes, Mucormycosis, Pulmonary tuberculosis

Abstract

Background and Purpose: Diabetes and immunosuppressive diseases have been reported as increased risk factors for developing invasive pulmonary tuberculosis and mucormycosis.

Case report: We presented here a case of a 55-year-old uncontrolled diabetic male with rhinosinus mucormycosis and pulmonary TB coinfection. Maxillary and ethmoid sinus involvement was observed in paranasal computed tomography. His chest computed tomography showed tree in the bud sign and cavitary lesions in the lungs. Mycobacterium tuberculosis was confirmed through molecular diagnosis using a realtime polymerase chain reaction assay. The nasal cavity biopsy revealed the fungal elements (aseptate hyphae) and confirmed mucormycosis infection. Amphotericin B liposomal, teicoplanin, and tazobactam were administered to treat the mucormycosis. The patient was successfully treated with a recommended four-drug regimen for TB without any adverse reaction.

Conclusion: The clinicians must consider tuberculosis and mucormycosis tests when confronted with an uncontrolled diabetic patient with clinical symptoms of hemoptysis, fever, and cavitary lesions.