Rhino-Orbita-Maxillary Mucormycosis After Liver Transplantation: A Case Report

Farojov, R.; Aydın, Özlem; Yilmaz, Cahit; Iakobadze, Zaza; Doğanay, Latife; Camlı, Dilsat; Demireller, Alp; Küçükgül, S.C.; Kılıç, Murat

doi:10.1016/j.transproceed.2016.08.016

Cited by 10 publications

(3 citation statements)

References 11 publications

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“…107 Only one case of mucormycosis (Lichtheimia) was identified among 362 heart transplant recipients at a single center from 1995 to 2012. 108 Numerous case reports and small series of mucormycosis in SOTRs including liver, 80,[109][110][111][112][113][114][115] kidney, 107,[116][117][118][119][120][121][122][123][124][125] heart, 108,126,127 and lung recipients [128][129][130][131] have been published.…”

Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

158

108

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Mucormycosis is an infection caused by a group of filamentous molds within the order Mucorales. Infections may result from ingestion of contaminated food, inhalation of spores into the nares or lungs, or inoculation into disrupted skin or wounds. In developed countries, mucormycosis occurs primarily in severely immunocompromised hosts (e.g., those with hematological malignancies, organ transplantation, neutropenia, autoimmune disorders, or other impairments in immunity). Only 6 to 10% of cases occur in subjects with no underlying disease. In contrast, in developing countries, most cases of mucormycosis occur in persons with poorly controlled diabetes mellitus or in immunocompetent subjects following trauma. Mucormycosis exhibits a marked propensity to invade blood vessels, leading to thrombosis, necrosis, and infarction of tissue. Mortality associated with invasive mucormycosis is high (> 30–50%), with 90% mortality associated with disseminated disease. Mortality rates are much lower, though still significant (10–30%), among patients with localized cutaneous disease.The diagnosis of mucormycosis relies upon histopathology and culture. Blood tests are of limited diagnostic value. Even with disseminated disease, blood cultures are usually negative. Mucorales have a distinct histological appearance, with irregular, nonseptate hyphae that branch at right angles. Cultures and/or polymerase chain reaction (PCR) are important to identify the genera.Based on anatomic localization, mucormycosis can be classified as one of six forms: (1) rhino-orbital-cerebral mucormycosis (ROCM), (2) pulmonary, (3) cutaneous, (4) gastrointestinal (GI), (5) disseminated, and (6) mucormycosis of uncommon sites. Among diabetics, ROCM is the most common clinical presentation, whereas lung involvement is uncommon. In contrast, among organ transplant recipients or patients with hematological malignancies (HemeM), pulmonary and disseminated diseases are most common. Mucormycosis can progress rapidly, and delay in initiation of treatment by even a few days markedly worsens outcomes.Due to the rarity of mucormycosis, randomized controlled therapeutic trials have not been performed. Lipid formulations of amphotericin B (LFAB) are the mainstay of therapy, but the newer triazoles, posaconazole (POSA) and isavuconazole (ISAV) (the active component of the prodrug isavuconazonium sulfate), may be effective in patients refractory to or intolerant of LFAB. Early surgical debridement or excision plays an important adjunctive role. Additional studies are required to assess the optimal duration of therapy as well as the specific roles of LFAB and the triazoles in the treatment of mucormycosis.

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Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

Mucormycosis

Reid

Lynch

Fishbein

et al. 2020

Semin Respir Crit Care Med

158

108

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“…148 Similarly, only one case of mucormycosis (Lichtheimia) was identified among 362 heart transplant recipients at a single center from 1995 to 2012. 149 Numerous case reports and small series of mucormycosis in SOT recipients including liver, 42,[150][151][152][153][154][155][156] kidney, 148,[157][158][159][160][161][162][163][164][165][166] heart, 149,167,168 and lung 55,[169][170][171] have been published.…”

Section: Organ Transplant Recipientsmentioning

confidence: 99%

Fungal Infections Complicating Lung Transplantation

Clark

Weigt

Fishbein³

et al. 2018

Semin Respir Crit Care Med

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Lung transplantation is an increasingly utilized modality for treating advanced lung disease. However, lung transplant recipients (LTRs) experience high rates of infection-related mortality and, compared with other solid organ transplant recipients, are at increased risk of infectious complications given the intensity of immunosuppression employed, the presence of airway abnormalities after surgery and exposure of the allograft to the environment. Fungal infections, particularly mold infections, are problematic after transplantation as they are often associated with limited treatment options and poor outcomes. We describe the non- fungal infections occurring in LTRs, including their epidemiology, clinical features, and treatment.

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“…Longer length of hospital stay in posttransplantation immunosuppressed patients may predispose them to multiple infections including mucormycosis [ 14 ]. A rare case report of rhino-orbital maxillary mucormycosis after solid organ transplantation has been reported in the nonpandemic era also [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Postliver Transplantation Rhino-Orbital Mucormycosis, an Unexpected Cause of a Downhill Course

Sabhapandit¹,

Sharma

Sekaran

et al. 2022

Case Reports in Hepatology

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The COVID-19 pandemic has impacted transplantation worldwide in a major way with infections and post-COVID-19 complications contributing to increased mortality and morbidity. We present a case of a 42-year-old lady who developed rhino-orbital mucormycosis in a postliver transplantation period. The initial presentation of the patient was very subtle. She never had overt COVID-19 infection before surgery and in the recovery period. Though cases of mucormycosis in the wound site have been reported, this would be one of the rare cases of rhino-orbital mucormycosis postliver transplantation. This infection leads to a rapid downhill course and the death of the patient. Atypical infections and presentations need to be monitored in postliver transplantation patients who are getting operated on during this pandemic, and a high level of clinical suspicion is required to pick up these cases at an early stage.

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Rhino-Orbita-Maxillary Mucormycosis After Liver Transplantation: A Case Report

Cited by 10 publications

References 11 publications

Mucormycosis

Mucormycosis

Fungal Infections Complicating Lung Transplantation

Postliver Transplantation Rhino-Orbital Mucormycosis, an Unexpected Cause of a Downhill Course

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