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Pulmonary Rhizopus infection in a diabetic renal transplant recipient
A Demirag1, E A Elkhammas, M L Henry
1The Ohio State University College of Medicine, Department of Surgery, Columbus 43210, USA.
Abstract:
Infectious complications after renal transplantation remain a major cause of morbidity and mortality. Mucormycosis is a rare infection in renal transplant recipients; however, mortality is exceedingly high. Risk factors predisposing to this disease include prolonged neutropenia, diabetes, and patients who are immunosuppressed (Singh N, Gayowski T, Singh J, Yu LV. Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report and review of zygomycosis in solid-organ transplant recipients, Clin Infect Dis 1995: 20: 617). Life-threatening infections can occur, as this fungus has the propensity to invade blood vessel endothelium, resulting in hematological dissemination. We report a case of cavitary Rhizopus lung infection, 2 months after renal transplantation, where the patient was treated successfully with Amphotericin B and surgical resection of the lesions with preservation of his allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in transplant population. Invasive diagnostic work-up is mandatory in case of suspicion; Amphotericin B and, in selected cases, surgical resection are the mainstays of therapy.
Insights
Mucormycosis is a rare but deadly fungal infection in kidney transplant patients. Successful treatment involves Amphotericin B and surgery, preserving allograft function.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Nephrology
Background:
- Infectious complications are a leading cause of morbidity and mortality post-renal transplantation.
- Mucormycosis, a rare fungal infection, carries an extremely high mortality rate in renal transplant recipients.
- Risk factors include immunosuppression, neutropenia, and diabetes.
Observation:
- A case of invasive cavitary Rhizopus lung infection occurred 2 months post-renal transplantation.
- The patient presented with symptoms suggestive of a serious fungal infection.
- The fungus exhibits a propensity for vascular invasion, leading to dissemination.
Findings:
- Successful treatment was achieved with Amphotericin B and surgical resection of lung lesions.
- Allograft function was preserved throughout the treatment course.
- Early and invasive diagnostic work-up is crucial for timely intervention.
Implications:
- Increased incidence of mucormycosis is anticipated in transplant populations due to intensified immunosuppression.
- Amphotericin B and surgical resection are the primary therapeutic strategies.
- Prompt diagnosis and management are vital for improving outcomes in transplant recipients with mucormycosis.