Lethal infection by Candida (Torulopsis) incospicua complicating orthotopic liver transplantation

Area of Science:

• Medical Mycology
• Transplant Surgery
• Infectious Diseases

Background:

• Liver transplantation is a complex procedure with risks of infection.
• Deep fungal infections can complicate immunosuppression in transplant recipients.
• Torulopsis incospicua is a rare cause of invasive fungal disease.

Observation:

• An orthotopic liver transplant recipient developed a deep infection with Torulopsis incospicua.
• The infection was associated with multibacterial sepsis, hepatic artery mycotic aneurysms, and liver graft necrosis.
• The patient required two re-transplants due to recurrent infections and aneurysms.

Findings:

• Despite aggressive management and multiple transplants, the patient experienced rapid relapses of infection and mycotic aneurysms.
• Disseminated mycosis was confirmed post-mortem.
• The case highlights the challenges in managing deep fungal infections post-liver transplant.

Implications:

• Fungal infections, particularly by rare yeasts like Torulopsis incospicua, should be considered in liver transplant recipients presenting with sepsis and vascular complications.
• Spontaneous hepatic artery rupture may be a sign of underlying fungal infection.
• This case underscores the need for heightened vigilance and prompt diagnosis of fungal infections in immunocompromised patients.