Rhinocerebral Mucormycosis in Renal Transplant Recipients: Report of Three Cases and Review of the Literature

Morduchowicz, G.; Shmueli, D; Shapira, Zachi; Cohen, Simon; Yussim, A.; Block, Colin; Rosenfeld, Joseph B.; Pitlik, Silvio

doi:10.1093/clinids/8.3.441

“…Mucormucosis accounts for 1-9 Yo of all invasive mycoses [13] and is associated with mortality rate as high as 64 YO [7]. The fungus enters the body through either the respiratory tract, the digestive tract, or a damaged skin barrier.…”

Section: Discussionmentioning

confidence: 99%

Mucormycosis of the renal allograft: case report and review of the literature

Chkhotua¹,

Yussim²,

Sobolev³

et al. 2001

Self Cite

View full text Add to dashboard Cite

Fungal infection is an uncommon complication after renal transplantation. We describe a rare form of mucormycosis in the renal graft. Our method was to review chart data and to perform medline searches. The patient was a 42-yearold man who underwent living-unrelated kidney transplantation in Egypt and returned to Israel on POD 8. Within the ensuing 4 weeks he experienced acute rejection which responded to treatment with steroids. Few days after discharge he was readmitted because of fever and graft dysfunction. An infected large perigraft collection was drained, but the patient became anuric and septic. Kidney biopsy showed infarcted necrotic tissue infiltrated by fungi which grew Mucur species. Despite initial improvement following graft nephrectomy and antifungal treatment the patient died of sepsis. Literature review revealed only three additional cases of graft infection due to Mucorales. We conclude that Renal graft infection due to Mucorales is an extremely rare and potentially lethal complication. Living unrelated donation in third world countries might be a possible risk factor. Fungal colonization may occur during transplantation. A high index of suspicion, leading to early diagnosis and initiation of antifungal treatment, in addition to graft nephrectomy, are keys to a more favorable outcome.

show abstract

“…They require a breakdown in the immune defenses, particularly disease processes that lead to neutropenia or neutrophil dysfunction. Although neutrophil dysfunction induced by ketoacidosis underlies the majority of cases of human zygomycosis, neutropenia induced by bone marrow suppression during chemotherapy or immunosuppression induced following transplantation is causing a growing proportion of cases (60,160,279,308,455). Disease is occasionally seen in competent hosts, however, usually associated with antibiotic use or a breakdown in the mucocutaneous barrier.…”

Section: Relationship Of the Zygomycetes To Other Fungi Causing Diseasementioning

confidence: 99%

“…First, steroids suppress the normal inflammatory cell response that would otherwise occur, and second, they may induce a diabetic state (291). Other immunocompromised states such as organ or bone marrow transplantation also contribute to the underlying risk factors for developing disease with these opportunistic infections (54,160,190,196,308). The use of broad-spectrum antibiotics has also been associated with an increased risk of developing zygomycosis.…”

Section: Risk Factors For Developing Zygomycosismentioning

confidence: 99%

“…Even with the poor showing with culture results, it soon became obvious that Rhizopus spp., and not Mucor spp., were the predominant organisms causing disease (286,321). Other important information was also being collected by astute clinicians and researchers regarding the association of zygomycosis with cancer (28,209,297), antibiotic or prednisone use (463), diabetes (181,260), deferoxamine and desferrioxamine therapy (48), transplantation (308), and the associated forms of immunosuppressive therapies. With the development of diagnostic tools that allowed earlier diagnosis, with better surgical and antifungal interventions, and with more sophisticated laboratory methods for identifying these agents, more patients are surviving these previously fatal infections.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Zygomycetes in Human Disease

Ribes¹,

Vanover-Sams²,

Baker³

2000

Clinical Microbiology Reviews

View full text Add to dashboard Cite

“…Mucormycosis is usually a rapidly progressive and frequently fatal infection in renal transplant patients [7]. Various manifestations of this infection in renal recipients have been described.…”

Section: Introductionmentioning

confidence: 99%

Mucormycosis of the renal allograft: case report and review of the literature

Chkhotua¹,

Yussim²,

Tovar³

et al. 2001

Transplant International

Self Cite

View full text Add to dashboard Cite

Fungal infection is an uncommon complication after renal transplantation. We describe a rare form of mucormycosis in the renal graft. Our method was to review chart data and to perform medline searches. The patient was a 42-yearold man who underwent living-unrelated kidney transplantation in Egypt and returned to Israel on POD 8. Within the ensuing 4 weeks he experienced acute rejection which responded to treatment with steroids. Few days after discharge he was readmitted because of fever and graft dysfunction. An infected large perigraft collection was drained, but the patient became anuric and septic. Kidney biopsy showed infarcted necrotic tissue infiltrated by fungi which grew Mucur species. Despite initial improvement following graft nephrectomy and antifungal treatment the patient died of sepsis. Literature review revealed only three additional cases of graft infection due to Mucorales. We conclude that Renal graft infection due to Mucorales is an extremely rare and potentially lethal complication. Living unrelated donation in third world countries might be a possible risk factor. Fungal colonization may occur during transplantation. A high index of suspicion, leading to early diagnosis and initiation of antifungal treatment, in addition to graft nephrectomy, are keys to a more favorable outcome.

show abstract

Rhinocerebral Mucormycosis in Renal Transplant Recipients: Report of Three Cases and Review of the Literature

Cited by 74 publications

References 17 publications

Mucormycosis of the renal allograft: case report and review of the literature

Mucormycosis of the renal allograft: case report and review of the literature

Zygomycetes in Human Disease

Mucormycosis of the renal allograft: case report and review of the literature

Contact Info

Product

Resources

About