Background Pulmonary mucormycosis (PM) is a rare but high mortality fungal infection, and relatively few clinical studies of PM have been conducted at home and abroad.

Objective To analyze the clinical features of PM and the risk factors affecting prognosis, and improve the understanding of PM.

Methods Clinical data about 46 patients with PM admitted to five medical centers of Chinese PLA General Hospital from January 2001 to March 2023 were retrospectively analyzed, and the clinical outcomes of patients with pulmonary mucormycosis were assessed at 90 days after diagnosis. Patients were divided into survival group and death group, and the covariates screened by a combination of univariate analysis, Lasso regression, and random forests were included in multifactorial logistic regression to analyze the factors related to PM prognosis.

Results A total of 46 patients with PM were included, the median age was 53.5 (range: 2-81) years, 35 (76%) cases were male. Diabetes mellitus and hematological malignant tumors were the main underlying diseases, clinical symptoms were mainly manifested as coughing and sputum and fever, the main imaging manifestations were solid lesions, nodules, cavities and pleural effusion. Sixteen cases died, with the mortality rate of 35%. Endotracheal intubation and respiratory-assisted respiration (OR=21.102, 95% CI: 2.058 to 216.397) was an independent risk factor for PM prognosis, while taking surgical treatment (OR=0.043, 95% CI: 0.003 to 0.695) was an independent protective factor for PM prognosis.

Conclusion PM often occurs in patients with diabetes mellitus and hematological malignancies with nonspecific clinical features and imaging manifestations, and early initiation of surgical and anti-Mucor therapy is the key to improving patients' prognosis.