title: Fulminant zygomycosis of graft liver following liver transplantation.
abstract: A 44-year-old man with hepatitis B virus (HBV)-related cirrhosis underwent living donor liver transplantation at our institute. Induction of immunosuppression was achieved with basiliximab, due to deranged renal function, and maintained with prednisolone, tacrolimus and mycophenolate mofetil. The intraoperative and immediate postoperative periods were fairly uneventful. A duplex scan, taken during the third week post-transplantation due to sudden rise in liver enzymes, revealed multifocal hypoechoic lesions in the graft liver with normal Doppler parameters. Multidetecor computed tomography (MDCT) showed multiple hypodense vessel-sparing lesions in the graft liver. Cultures from the aspirate grew filamentous fungi identified as Basidiobolus ranarum species. Despite multiple broad spectrum antifungal infusions including liposomal amphotericin, itraconazole, caspofungin and posaconazole, serial sonography showed the hepatic lesions increasing in size, and involving segments V, VI and VII. The patient developed severe liver dysfunction ultimately progressing to sepsis, multiorgan dysfunction and death.
authors.affiliation: Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Pulkit
authors.initials: P
authors.lastname: Sethi
authors.affiliation: Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Balakrishnan
authors.affiliation: Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Sudhindran
authors.initials: S
authors.lastname: Surendran
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Zubair Umer
authors.initials: ZU
authors.lastname: Mohamed
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D020091:Entomophthorales; D017809:Fatal Outcome; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D020096:Zygomycosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents