Abstract
BACKGROUND: Tracheobronchial mucormycosis (TM) is a rare and potentially fatal disease commonly occurred in immunocompromised individuals, with death risk from massive hemoptysis or asphyxia.To enhance clinical understanding, we retrospectively analyzed the clinical features, therapeutic regimen, and outcomes of TM patients. METHODS: We conducted a comprehensive analysis of hospitalized patients diagnosed with TM between January 1, 2010, and April 30, 2025, systematically collecting and evaluating data on clinical manifestations, treatment strategies, and clinical outcomes. RESULTS: Twenty patients were included in this study, with a median age of 56 years. Most patients had diabetes mellitus, followed by those with hematological malignancies. Common symptoms included cough, expectoration, hemoptysis, and fever. Chest CT revealed pulmonary infiltrates, bronchial stenosis or occlusion, obstructive pneumonia, and pleural effusion, while bronchoscopy revealed neoplasms, purulent secretions, and bronchial obstruction or stenosis.Metagenomic next-generation sequencing demonstrated a higher positive diagnostic rate and shorter time to diagnosis compared to histopathology and culture. Three patients received intravenous amphotericin B (AmB) monotherapy, eight patients were treated with a combination of intravenous and intratracheal AmB, one patient was treated with intravenous triazole drug alone, two patients received a regimen consisting of intravenous triazole drugs combined with intratracheal AmB, and five patients underwent triple therapy involving both intravenous triazole drugs and concurrent intravenous and intratracheal AmB administration. Additionally, one patient underwent bronchoscopic intervention, and two patients underwent lobectomy. Fourteen patients demonstrated clinical improvement, whereas six died. Massive hemoptysis was the leading cause of mortality. CONCLUSIONS: TM is a highly lethal disease that is often underdiagnosed. Bronchoscopy plays an essential role in both diagnosis and management. Systemic antifungal therapy, combined with intratracheal administration of AmB, has shown favorable therapeutic outcomes.