A222 - Opportunistic Fungal Infection by Mucorales in Liver Transplantation: Case Report

View session detail

Author Block: J. A. Lagarda Ramos, D. E. Lopez Garnica, M. Zacatenco Carreño, J. Carmona Martinez, C. E. Escareño Perez, Tecnologíco de Monterrey, Monterrey, Mexico
*Purpose: Infections in liver transplant recipients are linked to immunosuppression and commonly include bacteremia, opportunistic infections, and disease recurrence. Mucormycosis is a rare but lethal complication caused by Mucorales species (Rhizopus, Mucor, Lichtheimia). Its variable presentation complicates diagnosis and management. We present a liver transplant recipient who developed pulmonary mucormycosis with diaphragmatic extension and graft involvement, emphasizing the need for multidisciplinary care.
*Methods: A 71-year-old male with chronic liver disease due to nonalcoholic steatohepatitis and suspected hepatocellular carcinoma underwent orthotopic liver transplantation from a deceased donor with splenectomy for low portal flow. The explant revealed carcinosarcoma. He had an initially satisfactory postoperative course. Two months later, while on tacrolimus, methylprednisolone, and mycophenolate mofetil, he developed malaise, biliary tinged productive cough, and an 8/10 holocranial headache. He denied fever or focal deficits. Imaging revealed a segment VIII biloma with a bronchobiliary fistula and bilateral pulmonary opacities. Management included percutaneous drainage and ERCP. VATS resection of the fistula yielded a lung parenchyma sample positive for mucormycosis.. Antifungal therapy with amphotericin B and isavuconazole was started, followed by bilobectomy and transdiaphragmatic resection of segment VIII. Despite aggressive surgical and antifungal treatment, his clinical course deteriorated.
*Results: Evidence on mucormycosis in solid organ transplant recipients is limited. In a series of 183 cases, only 10% occurred in liver transplant recipients; 90-day and 1-year mortality were 36.3% and 63.4%. Risk factors include renal insufficiency, diabetes, and prior voriconazole or caspofungin exposure, whereas calcineurin inhibitors reduce risk up to fourfold. Management recommendations largely rely on expert opinion. For pulmonary mucormycosis, combined surgical and antifungal therapy improves survival compared with medical therapy alone. In liver transplant recipients, this infection remains rare but likely underrecognized.
*Conclusions: Opportunistic Mucorales infections after solid organ transplantation are uncommon but highly lethal. Early recognition, surgical debridement, and targeted antifungal therapy are essential to improving outcomes. This case highlights the poor prognosis of invasive fungal infections despite appropriate management.