Phycomycosis: A cause of bronchial obstruction

A patient with diabetes mellitus presented with an obstructing mycetoma in the right bronchus intermedius due to Phycomycetes. Review of the literature revealed eight prior case reports of patients with prominent endobronchial disease attributable to phycomycosis. Indolent, obstructing lesions in large bronchi were noted in diabetics. The clinical illness differed from the fulminant fungal pneumonia noted in leukemics but was also lethal because of localized complications such as erosion into the pulmonary artery. The differential diagnosis included mucoid impaction, bronchocentric granulomatosis, and mycotic bronchitis. Surgical resection appears to be the appropriate therapy for well localized bronchial lesions.