Endobronchial mucormycosis presenting as consolidation: diagnostic challenges and clinical recovery

Endobronchial mucormycosis is a rare and aggressive fungal infection that often presents with nonspecific respiratory symptoms, leading to delayed diagnosis. We report the case of a 74-year-old man with poorly controlled diabetes mellitus who presented with cough, hemoptysis, and non-resolving consolidation despite broad-spectrum antibiotics. Initial sputum evaluations, including bacterial culture, KOH mount, AFB smear, and CBNAAT, were inconclusive. Contrast-enhanced CT revealed consolidation with internal necrosis, prompting flexible bronchoscopy. Bronchoscopy showed a polypoidal endobronchial lesion, and biopsy confirmed mucormycosis with broad, aseptate hyphae. The patient was treated with intravenous amphotericin B, followed by oral posaconazole, along with strict glycaemic optimization. Gradual clinical and radiological improvement was observed, and complete resolution occurred over two months. This case highlights the importance of early bronchoscopy and histopathological confirmation in patients with persistent consolidation and negative sputum results, particularly in those with diabetes, to enable timely initiation of antifungal therapy and improve outcomes.