Abstract: FR-PO772
Revealing the Invisible: Invasive Mucormycosis in a Kidney Transplant Recipient
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Hughes, Natasha Cindy, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Mitchell, John P., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Gardner, Maryn, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Langone, Anthony J., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Shawar, Saed, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Introduction
Mucormycosis is a rare, life-threatening fungal infection; prompt diagnosis and intervention are critical for survival. We present a case where initial sinus CT imaging demonstrated minimal changes despite a severe invasive fungal infection. Further investigation underlined the necessity of nasal endoscopic biopsy to diagnose high-risk patients exhibiting progressive sinus symptoms.
Case Description
A 38-year-old male with ESRD secondary to Alport Syndrome had two kidney transplants, the most recent being a deceased-donor kidney transplant in 2/2022. He was induced with alemtuzumab and maintained on tacrolimus, mycophenolate mofetil, and prednisone.
His post-transplant course was complicated by antibody-mediated and cellular rejection in 12/2022, which were treated with PLEX, IVIG, rituximab, and thymoglobulin. His condition was stable until 3/2023 when he started having left-sided facial pain and congestion. A sinus CT scan showed mild mucosal thickening of the left maxillary sinus ethmoid cells. Levofloxacin was given for presumed bacterial sinusitis and a same-day ENT appointment was scheduled, but he was lost to follow-up.
Three weeks later, he presented with aggravated facial pain and left-sided numbness, with no other neurological or pulmonary symptoms. A follow-up sinus CT scan suggested progressive chronic sinusitis without aggressive features. However, given the concern for fungal infection, ENT was consulted and did a nasal endoscopy which revealed black and necrotic inferior and middle left turbinates, suggesting invasive fungal sinusitis.
The patient underwent surgical debridement and pathological examination confirmed invasive mucormycosis. Amphotericin therapy was initiated. A chest CT revealed a mass-like consolidation in the right middle lobe indicative of fungal pulmonary involvement. Following weekly debridements and amphotericin therapy, the patient improved and transitioned to isavuconazole therapy, further alleviating his symptoms.
Discussion
Invasive mucormycosis can manifest subtly in kidney transplant patients, with early CT scans often minimally indicative despite severe tissue damage. This emphasizes the importance of a high index of suspicion for invasive fungal sinusitis in patients presenting with severe progressive sinusitis and of prompt endoscopic evaluation and early treatment to enhance patient survival.