title: Mucormycosis extending from the surgical wound to the transplanted kidney: case report and literature review.
abstract: Mucormycosis is an opportunistic, life-threatening infection in organ transplant recipients. We report a case of surgical wound mucormycosis that extended to a transplanted kidney. The patient was a 59-year-old man who underwent a donation-after-cardiac-death kidney transplant 10 years after receiving a liver transplant. On day 10 after the kidney transplant, he presented with cutaneous and subcutaneous tissues necrotizing at his right lower abdominal surgical wound. The necrotic tissue biopsy and laboratory culture showed different causes, while a polymerase chain reaction quickly identified the causative fungus at the species level. Although the combination therapy consisted of immunosuppressant withdrawal, intravenous Liposome AmB, and aggressive surgical debridement; unfortunately, the cutaneous mucormycosis invaded his transplanted kidney, and the patient was given a graft nephrectomy and subsequent hemodialysis.  We review the literature and conclude that mucormycosis in organ transplant recipients is a rare and extremely severe complication. Polymerase chain reaction provides a rapid and accurate diagnostic technique for species identification. Early effective antifungal therapy combined with aggressive surgical intervention and judicious withdrawal of immunosuppressants appears to be indispensable for a favorable outcome.
authors.affiliation: Department of Urology, Huangpu Hospital, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. liang2046@163.com
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
authors.forename: Chang-xi
authors.initials: CX
authors.lastname: Wang
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
authors.forename: Xiang-an
authors.initials: XA
authors.lastname: Tu
authors.forename: Wenwei
authors.initials: W
authors.lastname: Wang
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Long-shan
authors.initials: LS
authors.lastname: Liu
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001706:Biopsy; D003646:Debridement; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D009091:Mucormycosis / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D009336:Necrosis; D009392:Nephrectomy; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012086:Reoperation; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B