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

Abstract

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.

Successful treatment of mucormycosis in a renal allograft recipient

“…Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt e-mail: ogheith@yahoo.com allograft and five extrarenal) were reported in English literature [2][3][4][5][6][7][8][9][10][11]. In all the 11 cases, the prognosis was poor and the story ended with either death of the patient or removal of the graft.…”

Invasive fungal infections: A diagnostic challenge

“…[1][2][3][4] Unlike recipients of liver or lung transplants who are especially vulnerable to invasive candidiasis and aspergillosis, the risk of IFI in kidney transplant recipients is low. [1][2][3][4] Zygomycosis comprises only 0.2%-1.2% of infections in renal transplant recipients.…”

“…[1][2][3][4] Unlike recipients of liver or lung transplants who are especially vulnerable to invasive candidiasis and aspergillosis, the risk of IFI in kidney transplant recipients is low. [1][2][3][4] Zygomycosis comprises only 0.2%-1.2% of infections in renal transplant recipients. [1][2][3][4] As per another large sized study mucormycosis occurred in 3 of 8,494 renal transplants between 2001 and 2006 and accounted for 28 of 1,208 cases of IFI among all SOT recipients.…”

“…[1][2][3][4] Zygomycosis comprises only 0.2%-1.2% of infections in renal transplant recipients. [1][2][3][4] As per another large sized study mucormycosis occurred in 3 of 8,494 renal transplants between 2001 and 2006 and accounted for 28 of 1,208 cases of IFI among all SOT recipients. [5] Currently, there are no recommendations regarding routine prophylaxis against fungal infections in renal transplant recipients.…”

“…[5] Currently, there are no recommendations regarding routine prophylaxis against fungal infections in renal transplant recipients. [1][2][3][4] The risk factors include T cell depleting drugs, neutropenia, renal failure, poorly controlled diabetes, prior voriconzole or caspofungin use, hematological malignancies, hematopoetic stem cell transplant (HSCT) and iron overload states. [2] Incidence is also higher in males.…”