Primary pulmonary mucormycosis associated with plasma cell myeloma

Abstract

Male patient, 71 years old, white, rural origin, heavy smoker with a history of fibroadenomatous hyperplasia of prostate and quick relief back pain. He was admitted to the Medicine Department with a diagnostic approach of community-adquired bronchopneumonia. Additional tests were conducted and a leptospira test was negative. The patient underwent a nephrology assessment and it was determined to transfer him to the Intensive Care Unit, requiring a previous purifying procedure. In the clinical observations made, a diagnosis of pulmonary-renal syndrome and/or rapidly progressive glomerulonephritis in acute renal failure was considered. The patient evolved unfavorably and was intubated and received mechanical artificial ventilation, presenting bloody secretions by endotracheal tube and disseminated intravascular coagulation. He remained in critical condition and died at 23 days of hospital stay with clinical diagnoses of systemic vasculitis, acute renal failure, hemorrhagic pneumonitis and multiple organ dysfunction syndrome. Morphological findings were noted at necropsy (myeloma kidney, bone marrow infiltration by immature plasma cells and metastatic calcifications in the lung interstitium, indicating hypercalcemia), which together with other clinical and laboratory findings (renal failure, anemia, and accelerated erythrocyte sedimentation) led to a diagnosis of neoplasm of plasma cells (plasma cell myeloma), complicated with primary pulmonary mucormycosis.  The patient died with multi-organ damage and failure.