Clinico-Pathologic Conferences Lichtheimia ramosa: A Fatal Case of Mucormycosis Cecilia Mouronte-Roibás, 1 Virginia Leiro-Fernández, 1 Maribel Botana-Rial, 1 Cristina Ramos-Hernández, 1 Guillermo Lago-Preciado, 2 Concepción Fiaño-Valverde, 3 and Alberto Fernández-Villar 1 1 Pulmonary Department, Hospital ´ Alvaro Cunqueiro, EOXI Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Estrada Clara Campoamor No. 341, 36312 Vigo, Spain 2 Critical Care Department, Hospital ´ Alvaro Cunqueiro, EOXI Vigo, Estrada Clara Campoamor No. 341, 36312 Vigo, Spain 3 Pathology Department, Hospital ´ Alvaro Cunqueiro, EOXI Vigo, Estrada Clara Campoamor No. 341, 36312 Vigo, Spain Correspondence should be addressed to Cecilia Mouronte-Roib´ as; cecilia.mouronte.roibas@sergas.es Received 10 June 2015; Accepted 17 November 2015 Copyright © 2016 Cecilia Mouronte-Roib´ as et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mucormycosis due to Lichtheimia ramosa is an infrequent opportunistic infection that can potentially be angioinvasive when afecting inmunocompromised hosts. We present a fatal case of mucormycosis, afecting a 56-year-old male with diabetes mellitus and siderosis, initially admitted to our hospital due to an H1N1 infection. Te subject’s clinical condition worsened and he fnally died because of a necrotizing bilateral pneumonia with disseminated mycotic thromboses due to Lichtheimia ramosa, which is an emerging Mucoralean fungus. Tis is an infrequent case because of the extent to which it afected a subject without overt immunocompromise. Tis case underlines the importance of an early premortem diagnosis and treatment in order to prevent rapid progression of this disease, as well as the need of considering mucormycosis when facing subjects with multiple emboli and fever unresponsive to usual antimicrobials. 1. Case Presentation A 56-year-old man was admitted with a one-week history of nonproductive cough, myalgias, dyspnoea, and fever (39 ∘ C). Te subject was a former smoker, with a daily intake of 104 g of alcohol. His past medical history included well-controlled type 2 diabetes mellitus and siderosis, which had been diagnosed by bronchoscopy afer fnding a mild interstitial pattern in the CT. Lung function was normal at all times and the patient was never treated with oral corticosteroids before hospital admission. He also sufered from lef renal agenesis. A chest radiograph showed a bilateral pneumonia and empirical treatment with meropenem and levofoxacin was started. Oseltamivir was also started empirically, given that this subject was admitted during later winter and at high risk of sufering an infection caused by the H1N1 infuenza virus. Worsening of the subject’s clinical condition prompted the performance of a computed tomography (CT) 5 days afer admission, which confrmed the diagnosis of pneumonia and incidentally found an acute pulmonary bilateral thromboem- bolism (Figures 1(a) and 1(b)). Low molecular weight heparin was started and oseltamivir was suspended afer a 5-day treatment due to negative H1N1 nasal swabs. A bronchoscopy was performed on the 7th day afer ad- mission and due to positive sputum cultures for Streptococcus pyogenes, the antibiotic therapy was switched to meropenem and cotrimoxazole. Transbronchial biopsies showed nonspe- cifc acute alveolar damage. Afer 9 days of progressive recovery, the subject’s clinical condition worsened again, with fever, high acute phase reactants, leukocytosis, odynophagia, and persistent neck pain. Antibiotics were switched again to meropenem and linezolid and a neck-CT plus a neck ultrasonography were performed, with fndings suggestive of a de Quervain sub- acute thyroiditis (Figure 2). High-dose corticosteroids were started (1.5 mg/kg/24 h). Another thoracic CT was performed 18 days afer admis- sion, showing multiple cavitary nodules and masses in both lungs (Figure 3), as well as hypodense areas in the right Hindawi Publishing Corporation Canadian Respiratory Journal Volume 2016, Article ID 2178218, 4 pages http://dx.doi.org/10.1155/2016/2178218