Gastric Mucormycosis in a Renal Transplant Patient Treated with Isavuconazole Monotherapy

Abstract

Gastrointestinal mucormycosis is a rare infection in solid organ transplant recipients. Our patient, a 79-year-old male, presented with severe dysphagia and odynophagia about 2 weeks after receiving a renal transplant. An upper gastrointestinal (UGI) endoscopy revealed esophagitis and gastric ulceration, the cultures from which grew Rhizopus species. A usual treatment strategy should include Amphotericin B as monotherapy or in combination with Posaconazole or Isavuconazole for such infections. Our patient was treated with Isavuconazole monotherapy, in an effort to minimize renal toxicity from Amphotericin B to the new allograft. Unique to our case was a successful clinical response and resolution of UGI lesions with Isavuconazole monotherapy. Due to the vagueness of presenting symptoms, such infections can be easily missed in an immunocompromised patient which can have tragic outcomes. Prompt diagnosis and modulation of immunosuppression are essential to decrease mortality and morbidity. Isavuconazole is a novel agent and can be used as a monotherapy for such infections, especially in renal transplant recipients.

Characterizing patients with rare mucormycosis infections using real-world data

“…The most common non-HM comorbidity in patients with HM and IM was essential primary hypertension (50.31% of patients), which seemed to be a unique finding compared with pooled data studies, although this could be because there was a large proportion of patients with hypertension in the overall HM cohort, and a large proportion of patients of ≥ 65 years of age. Interestingly, however, a history of hypertension has been observed in some individual case studies of patients with IM, suggesting a potential association between hypertension and IM that has not been reported in a larger patient population [ 26 – 28 ]. Additional research into these findings could help to further our understanding of the potential predictors of IM in patients with HM.…”

Gastric Mucormycosis: An Infection of Fungal Invasion into the Gastric Mucosa in Immunocompromised Patients

“…The radiological modalities such as CT scan or MRI of the abdomen usually reveal nonspecific findings such as mucosal wall thickening, mass, and reactive lymphadenopathy and prompts additional investigation with endoscopic or surgical biopsy of the lesions. EGD finding of ulcerated patchy mucosal lesions with overlying greenish or greyish exudate is a characteristic feature of gastric mucormycosis; however, biopsy of lesions is essential to differentiate it from gastric malignancy [ 4 , 8 , 21 ]. EGD alone does not help to make a definitive diagnosis, and additional testing with biopsy specimens is required.…”

A Rare Case of Drug-ResistantNocardia transvalensisInfection in a Renal Transplant Patient

“…Bacterial infections causing urinary tract infections, diarrhea, pneumonia, and wound infections are the most common scenarios 1 in the early posttransplant period. Highly invasive fungal infections have also been reported within first 4 weeks of transplantation, 2 and concurrent infections with fungal and viral etiology have also been reported within first 12 months of transplant. 3 Nocardia is a ubiquitous, slow-growing, variably acid-fast, gram-positive Bacillus .…”