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Cerebral mucormycosis after liver transplantation: a case report
1Department of Surgery, University of Miami School of Medicine, Florida, USA.
Abstract:
A fatal case of cerebral mucormycosis occurring shortly after liver transplantation is described. The patient was a 32-yr-old male with advanced end-stage liver disease manifested by tense ascites, spontaneous bacterial peritonitis, deepening jaundice and anuria requiring hemodialysis. The 3rd day after successful liver transplantation the patient developed acute respiratory failure, then focal motor signs. Computed tomography showed fluid in the left maxillary sinus, partial opacification of the ethmoid and sphenoid sinuses, and diffuse low density lesions in both cerebral hemispheres. Despite treatment for cerebritis and cerebral edema, the patient's pupils became fixed and dilated, and brain death was declared. Autopsy revealed mucor sinusitis and cerebritis. Mucormycosis is an opportunistic fungal infection occurring in patients with diabetic ketoacidosis, malignancy, or immunodeficiency, and in those receiving wide-spectrum antibiotics, corticosteroids, or cytotoxic therapy. Mucor most frequently involves the face, rhinocerebral disease predominating. These infections are difficult to treat, but are curable with aggressive and frequent surgical debridement, discontinuation or reduction of immunosuppressive therapy and amphotericin. The diagnosis of mucormycosis is very difficult to make in cases such as the present one, in which the typical presentation and classical signs are not present. A high index of suspicion based on identified risk factors may assist in more rapid diagnosis of this life-threatening mycosis.
Insights
A rare case of cerebral mucormycosis after liver transplant is presented. Early diagnosis is crucial for this life-threatening fungal infection, especially in immunocompromised patients.
Area of Science:
- Medical Mycology
- Transplant Surgery
- Neurology
Background:
- Liver transplantation is a life-saving procedure for end-stage liver disease.
- Immunosuppression is necessary post-transplant but increases susceptibility to opportunistic infections.
- Mucormycosis is a severe fungal infection with high mortality, often affecting immunocompromised individuals.
Observation:
- A 32-year-old male developed cerebral mucormycosis post-liver transplant.
- Symptoms included respiratory failure, focal neurological deficits, and sinus opacification on CT.
- Autopsy confirmed mucor sinusitis and cerebritis.
Findings:
- Cerebral mucormycosis is a rare but devastating complication following liver transplantation.
- Diagnosis can be challenging due to atypical presentations in transplant recipients.
- Risk factors include immunosuppression, diabetes, malignancy, and broad-spectrum antibiotic use.
Implications:
- A high index of suspicion is vital for early diagnosis of mucormycosis in at-risk patients.
- Prompt treatment involving surgical debridement, reduced immunosuppression, and antifungal therapy is critical.
- This case highlights the importance of recognizing unusual infections in the post-transplant setting.