Aortobronchial fistula induced by pulmonary mucormycosis in acute myeloid leukemia

A 51-year-old woman was admitted to our hospital with a diagnosis of acute myeloid leukemia (M1) in January 2002. During the course of induction therapy, she developed a fever and chest radiography revealed bilateral infiltrates. She was treated with broad-spectrum intravenous antibiotics and fluconazole, but her condition continued to worsen. She then began receiving amphotericin B, although there was no evidence of a fungal infection from the sputum culture and serologic testing. The patient soon became afebrile and improved clinically. On the 87th hospital day, however, she had a bout of abrupt massive hemoptysis and died of exsanguination. The diagnosis of aortobronchial fistula due to pulmonary mucormycosis was obtained at autopsy. Because of the angioinvasive tendency of mucormycosis, fatal hemoptysis in some patients with pulmonary mucormycosis has been reported, but most cases involve hemoptysis resulting from mucor invasion of the pulmonary artery. To our knowledge, this case represents the fourth description of pulmonary mucormycosis with fatal bleeding from the aorta.