Surgical-site mucormycosis infection in a solid-organ transplant recipient and a concise review of the literature

Abstract

Surgical-site mucormycosis infections in solid-organ transplant recipients are rare conditions, with only 15 previously reported cases. We describe a case of a 49-year-old man who received a liver transplant due to alcoholic cirrhosis. On postoperative day 14, necrosis was noticed at the surgical site. After mucormycosis was diagnosed, monotherapy with amphotericin was started along with surgical debridements. Due to continued clinical deterioration, triple antifungal therapy was started with amphotericin, micafungin and posaconazole. Treatment with a granulocyte-macrophage colony-stimulating factor was also started. Despite therapy, the patient expired on postoperative day 31. We review the risk factors for mucormycosis infection in solid-organ transplant recipients as well as evidence for current treatment options. We also review the 15 previously reported cases of surgical-site mucormycosis infections in solid-organ transplant recipients, including time to infection, infecting organisms, mortality and treatments.

Gastrointestinal mucormycosis following liver transplantation: lessons learnt

“…Fungal sepsis following LT is usually an opportunistic infection occurring within the first 2 months of transplant 5. Factors identified to be associated with fungal infections, specifically among liver transplant recipients, include preoperative steroid use, bacterial infections, prolonged use of antibiotics and long duration of transplant 6. Among the different fungal species known to cause infections, Candida remains the most common 1 5.…”

COVID-19, rejection, and cutaneous mucormycosis in a long-term liver transplant recipient – the vicious cycle of immunosuppression and opportunistic infections

“…Most probably, the long period of increased immunosuppression caused by the continuum COVID-19 infection-cellular rejection and their corresponding immunosuppressive treatments were capital for the development of the mucor infection, particularly considering that our patient also presented other risk factors such as poorly controlled DM with glycosilated hemoglobing >7% and chronic lymphedema. Interestingly, while other cases of cutaneous mucormycosis have been previously reported in LT recipients [5] , [6] , [7] , [8] , most of them occurred in the early post-transplant period, when immunosuppression is highest, and the site of infection was predominantly the surgical wound. In contrast, our case was diagnosed in the setting of long-term increased immunosuppression due to COVID-19 requiring steroids, followed by rejection after steroid tapering that required steroid pulses.…”

An unusual opportunistic infection causing lower gastrointestinal tract bleeding in a patient with severe alcoholic hepatitis, post‐liver transplantation

“…This highly invasive fungal infection is caused by the inhalation or inoculation of Mucorales spores, with the most common presentations being a rhino‐sino‐orbital and pulmonary disease. Surgical site and gastrointestinal mucormycosis is a rare but potentially lethal fungal infection in the post‐transplant setting 2–5 …”

“…Surgical site and gastrointestinal mucormycosis is a rare but potentially lethal fungal infection in the post-transplant setting. [2][3][4][5] We report a case of a 46-year-old man who presented with a history of gradually progressive jaundice, ascites, and grade-1 hepatic encephalopathy (HE). Informed consent was obtained from the patient's relatives for case publication.…”