title: Disseminated Mucormycosis With Cerebral Involvement Owing to Rhizopus Microsporus in a Kidney Recipient Treated With Combined Liposomal Amphotericin B and Posaconazole Therapy.
abstract: Three months after a kidney transplant, a man experienced an internuclear ophthalmoplegia. Magnetic resonance imaging found a punctuate hyperintensity of the brainstem. Afterwards, the patient presented with peripheral facial paralysis. A complete morphologic assessment showed an increase of the brainstem lesion, together with an excavated pulmonary nodule. Combination therapy with high-dose liposomal amphotericin B and voriconazole was begun for the putative aspergillosis. Owing to its atypical clinical presentation and negative detection of Aspergillus galactomannan antigen on sera, a biopsy specimen of the lung lesion was obtained. Histopathological and mycological investigations allowed the diagnosis of mucormycosis owing to Rhizopus microsporus. Accordingly, voriconazole was replaced with posaconazole. After 5 months, regression of the cerebral lesion was noted. Disseminated mucormycosis in solid-organ recipients is uncommon and mycological diagnosis is challenging. Mortality is high and is increased by diagnostic delay. Treating mucormycosis requires surgical debridement and appropriate antifungal therapy (usually intravenous liposomal amphotericin B). This report suggests that a combination of liposomal amphotericin B and posaconazole can be a therapeutic option in patients with a poor prognosis.
authors.affiliation: From the ITUN (Institut de Transplantation Urologie Néphrologie), Nantes, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Ville
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Talarmin
authors.forename: Alina
authors.initials: A
authors.lastname: Gaultier-Lintia
authors.forename: Régis
authors.initials: R
authors.lastname: Bouquié
authors.forename: Christine
authors.initials: C
authors.lastname: Sagan
authors.forename: Patrice
authors.initials: P
authors.lastname: Le Pape
authors.forename: Magali
authors.initials: M
authors.lastname: Giral
authors.forename: Florent
authors.initials: F
authors.lastname: Morio
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D011237:Predictive Value of Tests; D012233:Rhizopus / Q000187:drug effects* / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C068538:liposomal amphotericin B; C101425:posaconazole; D000666:Amphotericin B