Fatal cutaneous mucormycosis after kidney transplant.
Mucormycosis is an uncommon opportunistic infection that is caused by Mucorales from the Zygomycetes class. Patients with severe immunodeficiency admitted to the hospital are at greatest risk for developing this infection. Mucormycosis usually is transmitted in humans by inhalation or inoculation of spores in the skin or mucous membranes. A 66-year-old man developed a surgical wound infection at 1 week after kidney transplant that did not improve despite broad-spectrum antibiotics and debridement. He was transferred to our hospital 45 days after transplant and had fever and a large purulent wound that was surrounded by a black necrotizing margin. Immunosuppressive drugs were discontinued and the dosage of prednisolone was decreased. Massive debridement was performed but was incomplete because he had full-thickness abdominal wall necrosis. Histopathology showed broad fungal hyphae without septation, consistent with the diagnosis of mucormycosis. Despite antifungal therapy with amphotericin B and additional debridement, the patient died of septic shock at 52 days after kidney transplant. Cutaneous fungal infections should be considered in the differential diagnosis of any nonhealing infected wound that does not respond to broad-spectrum antibiotics, especially in patients with predisposing risk factors such as transplant.
From the Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Setareh
S
Davuodi
Seyed Ali Dehghan
SA
Manshadi
Mohammad Reza
MR
Salehi
Farhad
F
Yazdi
Mona
M
Khazravi
Jafar Taghizade
JT
Fazli
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D003646:Debridement; D003881:Dermatomycoses / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009091:Mucormycosis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D012772:Shock, Septic / Q000382:microbiology; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D007166:Immunosuppressive Agents