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Disseminated Mucormycosis in a Patient with Recent Kidney Transplantation: A Case Report and Review of the Literature

Mucormycosis is an invasive fungal infection commonly seen in diabetics and immunocompromised patients. We report a case of disseminated mucormycosis in a 47-year-old diabetic male who underwent deceased donor renal allograft transplantation about 5 weeks prior to presentation. Our patient presented...

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Autores principales: Hatahet, Mohamad Hazem, Narayanan, Mohanram, Cleaves, Constance, Zreik, Riyam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808793/
https://www.ncbi.nlm.nih.gov/pubmed/24167513
http://dx.doi.org/10.1159/000351517
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author Hatahet, Mohamad Hazem
Narayanan, Mohanram
Cleaves, Constance
Zreik, Riyam
author_facet Hatahet, Mohamad Hazem
Narayanan, Mohanram
Cleaves, Constance
Zreik, Riyam
author_sort Hatahet, Mohamad Hazem
collection PubMed
description Mucormycosis is an invasive fungal infection commonly seen in diabetics and immunocompromised patients. We report a case of disseminated mucormycosis in a 47-year-old diabetic male who underwent deceased donor renal allograft transplantation about 5 weeks prior to presentation. Our patient presented with increasing fatigue, diarrhea and oligoanuria and was found to have significant acute kidney injury. Doppler ultrasound of the allograft revealed segmental decreased renal perfusion in the upper pole of the allograft with moderate hydronephrosis. Nephrostomy tube placement yielded minimal urine output. An allograft biopsy showed diffuse C4d-positive staining and fungal hyphae suggestive of Mucor infection. Computed tomography (CT) imaging revealed a right upper lobe mass, a small hypodensity in the liver and normal findings in the head. Despite prompt management including discontinuation of immunosuppression, amphotericin B and allograft nephrectomy, the patient had a rapid decompensation, developed respiratory failure requiring intubation, hypotension and supraventricular tachycardia with multiple new areas of hypoattenuation on head CT – all of which ultimately resulted in his death. A review of the literature revealed that mucormycosis is a relatively rare disease with a cumulative 12-month incidence rate of 0.07% in solid organ transplant recipients. Disseminated disease was found in about 23% of cases, with a mortality rate of 96%.
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spelling pubmed-38087932013-10-28 Disseminated Mucormycosis in a Patient with Recent Kidney Transplantation: A Case Report and Review of the Literature Hatahet, Mohamad Hazem Narayanan, Mohanram Cleaves, Constance Zreik, Riyam Case Rep Nephrol Urol Published online: May, 2013 Mucormycosis is an invasive fungal infection commonly seen in diabetics and immunocompromised patients. We report a case of disseminated mucormycosis in a 47-year-old diabetic male who underwent deceased donor renal allograft transplantation about 5 weeks prior to presentation. Our patient presented with increasing fatigue, diarrhea and oligoanuria and was found to have significant acute kidney injury. Doppler ultrasound of the allograft revealed segmental decreased renal perfusion in the upper pole of the allograft with moderate hydronephrosis. Nephrostomy tube placement yielded minimal urine output. An allograft biopsy showed diffuse C4d-positive staining and fungal hyphae suggestive of Mucor infection. Computed tomography (CT) imaging revealed a right upper lobe mass, a small hypodensity in the liver and normal findings in the head. Despite prompt management including discontinuation of immunosuppression, amphotericin B and allograft nephrectomy, the patient had a rapid decompensation, developed respiratory failure requiring intubation, hypotension and supraventricular tachycardia with multiple new areas of hypoattenuation on head CT – all of which ultimately resulted in his death. A review of the literature revealed that mucormycosis is a relatively rare disease with a cumulative 12-month incidence rate of 0.07% in solid organ transplant recipients. Disseminated disease was found in about 23% of cases, with a mortality rate of 96%. S. Karger AG 2013-05-07 /pmc/articles/PMC3808793/ /pubmed/24167513 http://dx.doi.org/10.1159/000351517 Text en Copyright © 2013 by S. Karger AG, Basel http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.
spellingShingle Published online: May, 2013
Hatahet, Mohamad Hazem
Narayanan, Mohanram
Cleaves, Constance
Zreik, Riyam
Disseminated Mucormycosis in a Patient with Recent Kidney Transplantation: A Case Report and Review of the Literature
title Disseminated Mucormycosis in a Patient with Recent Kidney Transplantation: A Case Report and Review of the Literature
title_full Disseminated Mucormycosis in a Patient with Recent Kidney Transplantation: A Case Report and Review of the Literature
title_fullStr Disseminated Mucormycosis in a Patient with Recent Kidney Transplantation: A Case Report and Review of the Literature
title_full_unstemmed Disseminated Mucormycosis in a Patient with Recent Kidney Transplantation: A Case Report and Review of the Literature
title_short Disseminated Mucormycosis in a Patient with Recent Kidney Transplantation: A Case Report and Review of the Literature
title_sort disseminated mucormycosis in a patient with recent kidney transplantation: a case report and review of the literature
topic Published online: May, 2013
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808793/
https://www.ncbi.nlm.nih.gov/pubmed/24167513
http://dx.doi.org/10.1159/000351517
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