To the Editor.—
In their article in the June 1978 issue of the Archives (138:925-927, 1978), Agger and Maki identified common risk factors in three patients that predisposed them to nosocomial mucormycosis. These included corticosteroids, broad-spectrum antibiotics, respiratory failure, renal failure, and hyperglycemia associated with total parenteral nutrition. The following case is similar to those cited but lacks the factor of total parenteral nutrition, and the patient had only mild renal failure and mild hyperglycemia.
Report of a Case.—
A 55-year-old woman was transferred from her local hospital after one day of excruciating substernal pain occurring shortly after choking on a piece of ham. History included a chronic esophageal stricture secondary to lye ingestion. She had no other underlying illness. Roentgenograms indicated air in the pericardial tissue and a right pleural effusion.At surgery, a rupture of the distal esophagus was closed and the right pleural space and mediastinum were