Post-Lung Transplant Disseminated Mucormycosis Requiring Bilateral Nephrectomy: A Complex Case of Opportunistic Fungal Infection in an Immunosuppressed Host

 

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Post-Lung Transplant Disseminated Mucormycosis Requiring Bilateral Nephrectomy: A Complex Case of Opportunistic Fungal Infection in an Immunosuppressed Host

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Rakesh
Madhyastha
Mohamed Ibrahim ibrahim3@ccad.ae Cleveland Clinic Abu Dhabi Nephrology Abu Dhabi United Arab Emirates -
Fadi Hijazi hijazif@ccad.ae Cleveland Clinic Abu Dhabi Nephrology Abu Dhabi United Arab Emirates -
Rakesh Madhyastha madhyap@ccad.ae Cleveland Clinic Abu Dhabi Nephrology Abu Dhabi United Arab Emirates *
Fadi Hamed hamedf@ccad.ae Cleveland Clinic Abudhabi Pulmonology Abu Dhabi United Arab Emirates -
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Mucormycosis is an angioinvasive fungal infection caused by fungi of the order Mucorales. It predominantly affects individuals with impaired host defenses, such as those with uncontrolled diabetes, hematological malignancies, or under immunosuppression after organ transplantation. Disseminated mucormycosis with genitourinary involvement is exceedingly rare. This report describes an unusual presentation of disseminated mucormycosis post-lung transplant with extensive renal and bladder involvement requiring bilateral nephrectomy.

We conducted a detailed retrospective review of the clinical course, imaging,  histopathological findings, and surgical interventions of the patient who underwent bilateral lung transplantation for idiopathic pulmonary fibrosis. The patient was followed closely postoperatively, and all relevant clinical, laboratory, radiological, microbiological, and pathological data were reviewed. Diagnostic procedures included serial imaging (CT, MRI), cystourethroscopy, renal pelvic urine sampling, and tissue biopsies. Management decisions were guided by multidisciplinary input from transplant medicine, infectious diseases, nephrology, and urology teams. Antifungal therapy was initiated based on clinical suspicion and histopathological confirmation. Surgical intervention (bilateral nephrectomy) was performed in response to confirmed invasive mucormycosis with persistent renal involvement despite medical therapy.

The patient was followed closely postoperatively, and all relevant clinical, laboratory, radiological, microbiological, and pathological data were reviewed. Diagnostic procedures included serial imaging (CT, MRI), cystourethroscopy, renal pelvic urine sampling, and tissue biopsies. Management decisions were guided by multidisciplinary input from transplant medicine, infectious diseases, nephrology, and urology teams. Antifungal therapy was initiated based on clinical suspicion and histopathological confirmation. Surgical intervention (bilateral nephrectomy) was performed in response to confirmed invasive mucormycosis with persistent renal involvement despite medical therapy.

Disseminated mucormycosis should be considered in the differential diagnosis of transplant recipients presenting with atypical infections and progressive organ dysfunction. Early biopsy, aggressive antifungal therapy, and timely surgical intervention can improve outcomes in this otherwise lethal condition.

Kewords