Right Angle, Wrong Assumptions: A Case of Endobronchial Mucormycosis Presenting as a Pedunculated Mass Mimicking Malignancy

ABSTRACT

Pulmonary mucormycosis is an aggressive, angioinvasive fungal infection that carries high mortality. Endobronchial involvement is rare and may present as a pedunculated mass with associated parenchymal consolidation, mimicking lung cancer. We present a case of a 52‐year‐old male smoker with poorly controlled Type 2 diabetes mellitus, chronic obstructive pulmonary disease (COPD) and a history of pulmonary tuberculosis 19 years prior presented with a 6‐month history of cough and hemoptysis. Suspecting tuberculosis reactivation, he was empirically treated with anti‐tuberculosis therapy (ATT) for 6 months without clinical response. High‐Resolution Computed Tomography (HRCT) of the chest revealed a 4.9 cm hyperdense necrotic consolidation patch with internal calcification in the right upper lobe (RUL). Flexible video‐bronchoscopy demonstrated a pedunculated mass in the posterior segment of the RUL, clinically concerning for lung cancer. Biopsy of tissue revealed extensive necrosis, hyalinization and thick‐walled, broad, non‐septate fungal hyphae with characteristic right‐angle branching and spores, confirming pulmonary mucormycosis without evidence of malignancy or granulomatous disease. Endobronchial mucormycosis should be considered in patients with diabetes, chronic airway disease or post‐tuberculosis lung disease who present with non‐resolving endobronchial masses. Early bronchoscopic tissue sampling is essential to avoid delayed diagnosis and inappropriate empirical therapy.