[Non-fatal disseminated mucormycosis in a solid organ transplant].
BACKGROUND
Mucormycosis is a rare fungal infection occurring most frequently in immunocompromised patients. The pathogens are filamentous fungi, order of Mucorales. Disseminated mucormycosis is a severe, life treating disease. Early diagnosis is a major determinant for prognosis, however, it remains difficult. The management consists in an early antifungal therapy using lipid formulation of amphotericin B associated with an extensive surgical debridement. Despite this therapeutic of choice, the mortality of disseminated mucormycosis remains high.


METHODS
We report the case of disseminated mucormycosis in a 25 years old woman 9 months after a pulmonary transplantation. The clinical presentation included pulmonary and thyroid localization and the pathogen was Absidia corymbifera. The patient survived thanks to a large surgical debridement, and an early antifungal bitherapy by lipid formulation of amphotericin B and posaconazole.


CONCLUSIONS
The re-emergence and the high mortality of mucormycosis in solid organ transplant receiver show the necessity to find new therapeutic approaches. Posaconazole associated with liposomal amphotericin B could be an interesting option to treat disseminated mucormycosis and improve their outcome.
Minet
C
C
Unité de Pneumologie, Pôle de médecine aiguë communautaire, CHU de Grenoble, France. cminet@chu-grenoble.fr
Bonadona
A
A
Tabah
A
A
Karkas
A
A
Mescam
L
L
Schwebel
C
C
Hamidfar
R
R
Pison
C
C
Saint-Raymond
C
C
Faure
O
O
Salameire
D
D
Timsit
J-F
JF
D020095:Absidia; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000601:surgery; D016040:Lung Transplantation; D009091:Mucormycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D013959:Thyroid Diseases / Q000175:diagnosis* / Q000601:surgery; D014230:Triazoles / Q000008:administration & dosage
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B