Successful Treatment of Recurrent Pulmonary Mucormycosis in a Renal Transplant Patient: A Case Report and Literature Review

Abstract

Background. We describe the unusual case of a recently transplanted cadaveric renal transplant recipient who presented with recurrent pulmonary mucormycosis. Case Report. An 18-year-old man with end stage renal disease secondary to congenital renal agenesis status after cadaveric kidney transplant 4 months before presented with acute onset of fever, hemoptysis, and back pain. The patient underwent an emergent left lower lobectomy due to the critical nature of his illness. He was also treated with amphotericin with resolution of his symptoms. One week later, he had evidence of recurrent disease on imaging with a surgical site infection. He underwent reexploration with evacuation of an empyema and debridement of a surgical site infection. He was continued on IV antifungal therapy with isavuconazonium and amphotericin. Radiographic clearance of disease with three months of treatment was apparent with no evidence of recurrence at seven-month follow-up. Discussion. Opportunistic infections in solid organ transplant patients represent a significant source of morbidity and mortality. Most patients are treated with prophylactic anti-infective agents. However, rare infections such as pulmonary mucormycosis remain a risk. The transplant physician must be aware of these uncommon infections and their treatment strategies, including the management of uncommon recurrent disease.

Gastric Mucormycosis in a Renal Transplant Patient Treated with Isavuconazole Monotherapy

“…To the best of our knowledge, this is the first reported case of a patient with gastric mucormycosis after renal transplant successfully treated with Isavuconazole monotherapy. There has been one previous case report published where there was a successful result using Isavuconazole in addition to Amphotericin B and surgical debridement in disseminated pulmonary infection in a renal transplant patient [27]. We acknowledge that we present evidence from a single patient but we highlight the efficacy of Isavuconazole monotherapy in the treatment of mucormycosis in an immunocompromised patient.…”

First reported case of late recurrence of pulmonary mucormycosis in a renal transplant recipient with poorly controlled diabetes mellitus

“…Recurrence of mucormycosis has been described in various case reports and the time interval between the first occurrence and recurrence ranges from 1 week to 2.5 years. 4 , 5 , 6 Here, we have described a case of PM recurrence 8 years after its first occurrence, which is a much longer time interval in comparison with the available literature. Re‐infection is a possibility, but recurrence is more likely as the PM occurred at the same anatomical site.…”

“…PM is caused by inhalation of spores, resulting in pneumonia and later necrosis and infarction of the lung tissue 3 . The rate of recurrence of PM is high and has been reported in different literature 4–6 . Here, we report a case of PM in a renal transplant recipient with poorly controlled DM, first diagnosed in 2012 and treated with antifungal for 1 year with radiological resolution.…”

“…3 The rate of recurrence of PM is high and has been reported in different literature. 4 , 5 , 6 Here, we report a case of PM in a renal transplant recipient with poorly controlled DM, first diagnosed in 2012 and treated with antifungal for 1 year with radiological resolution. He was not prescribed secondary antifungal prophylaxis and the PM recurred in 2020 at the same site.…”

Hemoptysis in Renal Transplant Recipients

“…Ηemoptysis in renal transplant recipients, as immunocompromised patients, can occur in the context of infections (tuberculosis, mycetoma, invasive pulmonary aspergillosis, necrotizing parenchymal pneumonia, parasitic infection) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]32]. Hemoptysis can also occur in the context of post-transplant malignancy due to immunosuppression (bronchial cancer, pulmonary metastases from other primary site) [28][29][30]33], in the context of potential drug toxicity [21][22][23][24][25][26]34], use of anticoagulants or antiplatelet agents [34], pulmonary embolism [35] or bronchiectasis due to recurrent pulmonary infections [36].…”