Abstract
Mucormycosis is an uncommonly encountered fungal infection in solid organ transplantation. The infection is severe and often results in a fatal outcome. The most common presentations are rhino-sino-orbital and pulmonary disease. We describe a rare case of gastric mucormycosis in a patient with a combined liver-kidney transplant affected by glycogen storage disease type Ia.A 42-year-old female patient presented with gastric pain and melena 26 days after transplantation. Evaluation with upper endoscopy showed two bleeding gastric ulcers. Histological examination of gastric specimens revealed fungal hyphae with evidence of Mucormycetes at subsequent molecular analysis. Immunosuppressive therapy was reduced and antifungal therapy consisting of liposomal amphotericin B and posaconazole was promptly introduced. Gastrointestinal side effects of posaconazole and acute T-cell rejection of renal graft complicated management of the case. A prolonged course of daily injections of amphotericin B together with a slight increase of immunosuppression favored successful treatment of mucormycosis as well as of graft rejection. At 2-year follow-up, the woman was found to have maintained normal renal and liver function. We conclude that judicious personalization of antimicrobial and antirejection therapy should be considered to resolve every life-threatening case of mucormycosis in solid organ transplantation.
Highlights
Mucormycosis is an uncommonly encountered fungal infection in solid organ transplantation
Cases of mucormycosis in combined liver-kidney transplantation are rarely reported in the literature [22]; to the best of our knowledge, this is the first case of gastric mucormycosis in a combined liver-kidney transplantation
Gastric mucormycosis frequently presents with epigastric pain, melena, and hematemesis; upper gastrointestinal endoscopy usually shows a solitary or multiple ulcers mimicking a common peptic ulcer [10]
Summary
Mucormycosis is an uncommonly encountered fungal infection in solid organ transplantation. Management of mucormycosis was based on a prompt start of appropriate antifungal therapy and a reversal of underlying predisposing factors for infection, such as immunosuppressive therapy. On POD 42, she started induction antifungal therapy with intravenous liposomal amphotericin B at a dose of 5 mg/kg per day; after 5 days, this drug was switched to oral posaconazole at a dose of 100 mg 3 times a day (target trough level > 2 mg/mL).
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