Disseminated Mucormycosis from Marijuana Use in a Renal Transplant Patient

Mucormycosis is a serious fungal infection that typically affects immunocompromised patients. We present a case of disseminated mucormycosis infection in a 34-year-old male with a history of marijuana use and focal segmental glomerulosclerosis who underwent living unrelated kidney transplant. After his transplant, he developed recurrent focal segmental glomerulosclerosis. Two months later, he developed pleuritic chest pain and imaging revealed a ground glass opacity with a surrounding dense consolidation within the right upper lobe, concerning for an angioinvasive fungal infection. During the hospitalization, his creatinine increased, and a biopsy of the allograft kidney demonstrated acute tubulointerstitial nephritis, acute vasculitis, and glomerular intracapillary fibrin thrombi with angioinvasive Mucorales fungal infection. The patient subsequently underwent transplant nephrectomy. Grossly, the allograft was pale white to dusky tan-red with poorly delineated cortical medullary junctions. Microscopic examination revealed necrotic tubules with a dense neutrophilic infiltrate, multinucleated giant cells, and ribbon-like, aseptate hyphae. A Gomori's methenamine silver stain highlighted the fungal elements, which were morphologically consistent with Mucorales. Review of the literature revealed that the incidence of mucormycosis within the first year is low at approximately 0.07% for renal transplant patients with an estimated overall mortality of 40-50%. Additionally, few case reports have been published demonstrating marijuana use as a cause of pulmonary mucormycosis or even disseminated disease. The purpose of our case report is to add knowledge to the presenting symptoms and investigate the association of marijuana use with pulmonary and disseminated mucormycosis.