Invasive Gastrointestinal Zygomycosis in a Liver Transplant Recipient: Case Report and Review of Zygomycosis in Solid-Organ Transplant Recipients

Abstract

Zygomycosis is a rare but highly invasive fungal infection that occurs in transplant recipients. We report a case of invasive gastrointestinal zygomycosis that occurred in a heavily immunosuppressed liver transplant recipient 5 days after retransplantation and that presented as gastric perforation. Despite aggressive surgical and antifungal therapy, the patient died. We review 46 cases of invasive zygomycosis in solid-organ transplant recipients. The rhinocerebral form of zygomycosis occurred in 57% of cases; the pulmonary, cutaneous, and disseminated forms each occurred in 13%; the renal form occurred in 2%; and the gastrointestinal form occurred in 2%. The infection ensued a median of 2 months after transplantation (range, 5 days to 8 years). Seventy-six percent of the patients had diabetes or had received antirejection therapy, mainly in the form of corticosteroids, before the onset of zygomycotic infection. The mortality for patients who received antifungal therapy and/or who underwent surgery was 50% for those who had rhinocerebral zygomycosis, none for those who had pulmonary and cutaneous zygomycosis, and 100% for those who had disseminated zygomycosis. Knowledge of the diverse clinical manifestations (including gastrointestinal involvement, as is illustrated by our case) and predisposing factors in transplant recipients with zygomycosis can aid in early recognition of this disease in this patient population.

Outbreak of Intestinal Infection Due to Rhizopus microsporus

“…Our enhanced surveillance of stool culture picked up six additional patients (cases 6, 7, and 9 to 12) with asymptomatic colonization by R. microsporus and one other (case 4) with mucosal involvement as evidenced by segmental thickening of the proximal jejunal wall shown in a computerized tomography study. In contrast to the previous reports of invasive disease (2,3,20,42), the organism could act as a colonizer or produce mucosal invasion in the gastrointestinal tract in the immunocompromised host, similar to that of Candida species. However, further investigation should be conducted to understand the natural evolution of clinical progression from colonization to invasion and whether there is any intracellular latency of Mucorales in the gastrointestinal tract in order to determine the optimal treatment and preventive strategy for this new clinical entity.…”

A fatal case of gastrointestinal mucormycosis in immunosuppressed host

“…Gastrointestinal mucormycosis is relatively rare, with stomach and the colon being the most frequent sites of involvement. 3 Hepatic mucormycosis after herbal medication ingestion has been reported previously. Typical risk factors for gastrointestinal mucormycosis include malnutrition (kwashiorkor), premature birth, intrinsic gastrointestinal tract abnormalities or immunosuppresion.…”

“…Typical risk factors for gastrointestinal mucormycosis include malnutrition (kwashiorkor), premature birth, intrinsic gastrointestinal tract abnormalities or immunosuppresion. 3 Other reasons for proposed increase in the incidence of mucormycosis include widespread use of newer, broadspectrum antifungal agents such as Voriconazole (unknown is association vs. causation) in the prophylaxis and treatment in select patients.…”

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

“…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.…”