D174 - Unveiling the Uncommon: A Rare Case of Mucormycosis in Kidney Transplant Allograft

View session detail

Author Block: N. Wareing¹, B. S. Brown², G. Jagannathan¹, T. Nicholas¹, W. Kitchens¹, P. Vasanth³, ¹Emory University, Atlanta, GA, ²Nephrology, Emory University, Atlanta, GA, ³Emory University, Decatur, GA
*Purpose: We present a life-threatening case of Mucormycosis affecting a kidney transplant allograft. This rare infection illustrates the critical necessity for swift intervention, as early graft nephrectomy was life-saving, emphasizing the complexity of managing this devastating condition.
*Methods: Description: A 49-year-old male with end-stage renal disease due to hypertension and obesity (BMI of 36 kg/m²) presented post-deceased renal donor transplant. His medical history included chronic pancreatitis and chronic deep vein thrombosis, managed with Eliquis. The transplant, complicated by delayed graft function, required hemodialysis for two weeks. He was maintained on belatacept, tacrolimus, Cellcept, and prednisone. His creatinine improved to 4.41 mg/dL at discharge but increased to 12 mg/dL one week later, accompanied by oliguria, fever, and diarrhea. Labs revealed leukopenia and negative blood and urine cultures. CT scans showed pyelonephritis. The renal allograft biopsy confirmed mucormycosis.
*Results: Summary: Due to the threat of disseminated fungal infection, an urgent explantation of the transplanted kidney was performed. The procedure revealed extensive adhesions and significant infarction in the allograft, with thick, murky fluid indicative of Pseudohyphae. Immunosuppression was halted, and antifungal therapy with Amphotericin B and isavuconazole was initiated. Cultures from the allograft grew Rhizopus, linked to Mucormycosis. The patient was later discharged on isavuconazole and is now stable on hemodialysis. This case raises concerns about potential donor-derived infection, as such isolated renal infections from this fungus are uncommon.
*Conclusions: Renal graft infection due to Mucorales is extremely rare and can be lethal. Early diagnosis, prompt antifungal treatment, discontinuation of immunosuppression, and emergent nephrectomy are critical for a favorable outcome.