Successful Treatment of Mucormycosis and Azole-Resistant Aspergillus Coinfection in a Diabetic Patient: A Case Report

作者：Tingting Zhao, Fang Yuan, Qiuhui Wu, Minke Shi, Yueyan Ni, Ruyi Zou, Mengying Liu, Weiwei Wu, Xin Su · 发表于：Infection and Drug Resistance · 年份：2025 · DOI：10.2147/idr.s530615 · 被引用次数：2 · 研究领域：Antifungal resistance and susceptibility、Fungal Infections and Studies、Pneumocystis jirovecii pneumonia detection and treatment

Objective: To report a case of coinfection with mucormycosis and azole-resistant Aspergillus fumigatus in a patient with poorly controlled type 2 diabetes, highlighting successfully treated with high-dose posaconazole combined with liposomal amphotericin B and lobectomy. Methods: A 52-year-old man who presented to our hospital with a 1-month history of fever accompanied by productive cough and sputum. He had type 2 diabetes with poor control of glucose level. Chest computed tomography (CT) showed rapidly progressive multiple cavities and consolidation in the lungs. Sputum culture showed azole-resistant Aspergillus fumigatus , confirmed by whole genome sequencing, which revealed mutations in non-azole target genes (eg, CYP51A was wild-type). Targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF) at admission detected Aspergillus fumigatus and Rhizopus microsporus , while histopathology of right upper lobe necrotic material on day 18 confirmed mucormycosis. The patients had previously received intravenous voriconazole (400 mg/d) combined with inhaled amphotericin B (10 mg twice daily) for 2 weeks without improvement. Upon admission, initial treatment with isavuconazole, liposomal amphotericin B, and caspofungin was also ineffective. Subsequently, high-dose posaconazole (600 mg/d) combined with liposomal amphotericin B was administered. Results: Following the initiation of high-dose posaconazole and liposomal amphotericin B, the patient’s temperature n...