Extensive sino-orbital zygomycosis after heart transplantation: a case report

Zygomycosis is an opportunistic fungal infection mainly affecting patients with diabetes mellitus, immunodeficiency, and malignancies. The majority of cases in which it has been reported as a posttransplantation complication have been after renal or liver transplantation. There are few instances of rhino-sinusitis and orbital mucormycosis complicating heart transplantation.

A 38-year-old diabetic man who had undergone heart transplantation returned to the transplantation follow-up clinic 20 days after a successful operation with unilateral periorbital swelling, nasal discharge, and multiple cranial nerve dysfunctions. Multidisciplinary investigations resulted in detection of mucormycosis in the paranasal sinuses and the orbital space, as well as a thrombosis of the cavernous sinus. Surgical ablation of the infected parts, along with antifungal treatment and adjustment of immunosuppressive maintenance, restricted extension of the craniofacial involvement. Allograft function remained undisturbed.

Early detection of opportunistic infections in transplant recipients plays a big role in preventing dissemination. Fungal infections, including zygomycosis, should be considered for recipients, especially those with risk factors, such as diabetes, who present with local unusual manifestations. Sinonasal and orbital mucormycosis, if diagnosed in timely fashion, can be managed to reduce mortality. Although devastation of one-side facial and ophthalmic structures was inevitable in this case, the overall outcome was acceptable.