Pulmonary mucormycosis in a patient with kidney transplant and uncontrolled haemoptysis

• Published in: Revista iberoamericana de micologia Vol. 34; no. 4; p. 233
• Main Authors: Navarro Vergara, Dulce Iliana, Barragán Pola, Gloria, Bonifaz, Alexandro, Núñez Pérez-Redondo, Carlos, Choreño García, Omar, Cicero Sabido, Raúl
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.10.2017
• Subjects: Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Biopsy, Fine-Needle; Diabetes Mellitus, Type 2 - complications; Diabetic Nephropathies - surgery; Fatal Outcome; Female; Hemoptysis - etiology; Humans; Immunocompromised Host; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Kidney Failure, Chronic - surgery; Kidney Transplantation; Lung - microbiology; Lung - pathology; Lung Diseases, Fungal - complications; Lung Diseases, Fungal - drug therapy; Lung Diseases, Fungal - microbiology; Middle Aged; Mucormycosis - complications; Mucormycosis - drug therapy; Mucormycosis - microbiology; Postoperative Complications - drug therapy; Postoperative Complications - microbiology; Rhizomucor - isolation & purification; Hemoptisis incoercible; Kidney transplant; Trasplante renal; Pulmonary mucormycosis; Mucormicosis pulmonar; Rhizomucor pusillus; Uncontrolled haemoptysis
• ISSN: 2173-9188
• DOI: 10.1016/j.riam.2017.03.005

Pulmonary mucormycosis is a rare opportunistic infection with high mortality that is caused by species of Mucorales. The most common species involved are Rhizopus, Mucor, Lichtheimia, and Rhizomucor. A 56 year-old woman presented with a clinical history of diabetes mellitus type 2 and chronic renal disease. She underwent a cadaveric kidney transplantation two years before her admission, for which immunomodulating therapy with thymoglobulin, tacrolimus, mofetil-microphenolate and prednisone was established. The patient suffered a pneumonic process with cough, expectoration, and dyspnoea. The computed tomography scan showed a cavitation in the right upper lobe. With all these findings an invasive broncopulmonary aspergillosis was suspected and the patient began an antifungal treatment with voriconazole without improvement. Rhizomucor pusillus was isolated from a clinical specimen obtained by fine needle aspiration, and its identification was confirmed by PCR. After this finding amphotericin B was administered, but the patient had an uncontrolled haemoptysis and died. Pulmonary mucormycosis is a rare infection, usually fatal in kidney transplant recipients with anti-rejection therapy. Mucorales species usually produce thrombotic phenomena, associated with necrosis and parenchymal destruction that caused a fatal uncontrolled haemoptysis in our patient. Early diagnosis is important in order to perform any surgical treatment and to administer amphotericin B.