Lessons to be learned from a complicated case of rhino-cerebral mucormycosis in a renal allograft recipient.
Fungal infections still represent a serious complication after organ transplantation. Early diagnosis and aggressive treatment are crucial. Because of the many diagnostic problems involved, we present a case of mucormycosis--primarily affecting the paranasal sinuses with later intracranial extension--in a highly immunized recipient of a third renal transplant. Although fungal infection was suspected from various imaging techniques, only the detection of typical fungal hyphae in the infected tissue was diagnostic. Neither the blood tests and cerebrospinal fluid examinations performed nor cultures from maxillary sinus fluid were of any diagnostic help. Surgical debridement from a transnasal as well as an intracranial approach and systemic amphotericin B together with the discontinuation of immunosuppression after removal of the rejected graft were able to save the patient. This case stresses the importance of early diagnosis that can only be made from tissue biopsies and allows appropriate timely treatment.
Ladurner
Ruth
R
Department of Transplant Surgery, Innsbruck University Hospital, Anichstrasse 35, 6020 Innsbruck, Austria. rladurner@hotmail.com
Brandacher
Gerald
G
Steurer
Wolfgang
W
Schneeberger
Stefan
S
Bösmüller
Claudia
C
Freund
Martin Clemens
MC
Kreczy
Alfons
A
Königsrainer
Alfred
A
Margreiter
Raimund
R
D002648:Child; D004660:Encephalitis / Q000209:etiology / Q000473:pathology; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008297:Male; D009091:Mucormycosis / Q000209:etiology* / Q000473:pathology; D010256:Paranasal Sinuses / Q000382:microbiology / Q000473:pathology; D011183:Postoperative Complications; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents