A Rare Case Requiring Emergency Tracheotomy, Isolated Tracheal Mucormycosis: It is Important to Suspect First

Year 2025, Volume: 16 Issue: 1, 14 - 18, 28.03.2025

Bilge Tuna , Gökhan Tüzemen , Emine Kıyım Altıntaş

Abstract

Introduction: Mucormycosis is asignificant opportunistic infection, ranking as the third most common invasive fungal infection after candidiasis and aspergillosis.
Case report: A 67-year-old male patient was evaluated for progressive shortness of breath. Intubation tube could not be passed through the subglottic region. An emergency tracheotomy was performed. After the tracheal incision, a gray mass and necrotic material were encountered in the tracheal lumen. The tracheal biopsy result was mucormycosis.
Conclusion: In cases of emergency tracheotomy for respiratory tract obstruction, it should be kept in mind that when an obstructive mass or necrotic material is encountered in the trachea, this may be a focus of infection requiring rapid treatment. Perioperative frozen examinations are recommended for swift differential diagnosis of potential invasive fungal infection for in immunocompromised diabetic patients.

Keywords

emergency tracheotomy, tracheal mucormycosis, upper airway obstruction, invasive fungal infection

Ethical Statement

Bursa Şehir Hastanesi Etik kurul bilgisi dahilinde Başhekimlik'ten alınan 27.01.2022 tarihli ''Veri Kullanım İzni'' belgesi ekte sunulmuştur

Supporting Institution

yok

References

• 1. Milner S, Bennett J. Emergency cricothyrotomy. Journal of Laryngology and Otology 1991; 105: 883– 5.
• 2. Win Cheng LT, Sim TB, Kuan WS. Noninvasive ventilation as a temporizing measure in critical fixed central airway obstruction: A cese report. J Emerg Med 2018 May;54(5):615-618. DOI:10.1016/j.jemermed.2017.12.059.
• 3. Luo LC, Cheng DY, Zhu H, Shu X, Chen W-B. Inflammatory pseudotumoral endotracheal mucormycosis with cartilage damage. Eur Respir Rev 2009 Sep;18(113):186-9. DOI: 10.1183/09059180.00000709.
• 4. Aquino SL, Shepard JA, Ginns LC, et al. Acquired tracheomalacia: detection by expiratory CT scan. J Comput Assist Tomogr 2001;25:394-9.
• 5. Wolf O, Gil Z, Leider-Trejo L, Khafif A, Biderman P, Fliss DM. Tracheal mucormycosis presented as an intraluminal soft tissue mass. Head Neck 2004 Jun;26(6):541-3. DOI:10.1002/hed.20055.
• 6. BMJ Best practice. Central airway obstruction. Available at: 2017. http://bestpractice.bmj.com/best-practice/monograph/1069.html. Accessed June 4, 2017.
• 7. Ernst A, Feller-Kopman D, Becker HD, et al. Central airway obstruction. Am J Respir Crit Care Med 2004;169:1278-97.
• 8. Theodore PR. Emergent management of malşgnancy-releated acute airway obstruction. Emerg Med Clin North Am 2009;27:231-41.
• 9. Patel A, Pearce A. Progress in management of the obstructed airway. Anesthesia 2011;66(Suppl 2):93-100.
• 10. Kinnear W, Watson L, Smith P, et al. Effect of expiratory positive airway pressure on tidal volume during noninvasive ventilation. Chron Respir Dis 2017;14:105-9.
• 11. Fallahi MJ, Nikandish R, Ziaian B, Shahriarirad R. Near-Complete tracheal obstruction due to mucormycosis: A report of two cases. Clin Case Rep 2022 Aug 24;10(8):e6278. DOI:10.1002/ccr3.6278.
• 12. He R, Hu C, Tang Y, Yang H, Cao L, Niu R. Report of 12 cases with tracheobronchial mucormycosis and a review. Clin Respir J 2018 Apr;12(4):1651-1660. DOI:10.1111/crj.12724.
• 13. Mohindra S, Gupta B, Gupta K, Bal A. Tracheal mucormycosis pneumonia: a rare clinical presentation. Respir Care 2014 Nov;59(11):e178-81. DOI:10.4187/respcare.03174.
• 14. Damaraju V, Agarwal R, Dhooria S, et al. Isolated tracheobronchial mucormycosis: Report of a case and systematic review of literatüre. Mycoses. 2023 Jan;66(1):5-12. DOI:0.1111/myc.13519.
• 15. Dilek A, Ozaras R, Ozkaya S, Sunbul M, Sen EI, Leblebicioglu H. COVID-19-associated mucormycosis: Case report and systematic review. Travel Med Infect Dis 2021 Aug 26;44:102148. DOI:10.1016/j.tmaid.2021.102148.
• 16. Greenberg RN, Scott LJ, Vaughn HH, Ribes JA. Zygomycosis (mucormycosis): emerging clinical importance and new treatments. Curr Opin Infect Dis 2004;17(6):517-525.
• 17. Damaraju V, Agarwal R, Prabhakar N, et al. Isolated tracheal mucormycosis in diabetes mellitus and bronchoscopic management. Lung India. 41(3):p 226-227, May–Jun 2024.
• 18. Chen GJ, Chen XB, Rao WY, et al. Airway necrosis and granulation tissue formation caused by Rhizopus oryzae leading to severe upper airway obstruction: a case report. Front Cell Infect Microbiol. 2024 Mar 4:14:1366472. DOI:10.3389/fcimb.2024.1366472.
• 19. Papagiannopoulos P, Lin DM, Al-Khudari S, et al. Utility of intraoperative frozen sections in surgical decision making for acute invasive fungal rhinosinusitis. Int Forum Allergy Rhinol 2017;7(5):502-507. DOI:10.1002/alr.21918.