Zhao Liang, Wang Chang-xi, Zhang Ling, Tu Xiang-an, Wang Wenwei, Chen Yu, Liu Long-shan
Department of Urology, Huangpu Hospital, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Exp Clin Transplant. 2012 Aug;10(4):403-5. doi: 10.6002/ect.2011.0107. Epub 2012 May 14.
Mucormycosis is an opportunistic, life-threatening infection in organ transplant recipients. We report a case of surgical wound mucormycosis that extended to a transplanted kidney. The patient was a 59-year-old man who underwent a donation-after-cardiac-death kidney transplant 10 years after receiving a liver transplant. On day 10 after the kidney transplant, he presented with cutaneous and subcutaneous tissues necrotizing at his right lower abdominal surgical wound. The necrotic tissue biopsy and laboratory culture showed different causes, while a polymerase chain reaction quickly identified the causative fungus at the species level. Although the combination therapy consisted of immunosuppressant withdrawal, intravenous Liposome AmB, and aggressive surgical debridement; unfortunately, the cutaneous mucormycosis invaded his transplanted kidney, and the patient was given a graft nephrectomy and subsequent hemodialysis. We review the literature and conclude that mucormycosis in organ transplant recipients is a rare and extremely severe complication. Polymerase chain reaction provides a rapid and accurate diagnostic technique for species identification. Early effective antifungal therapy combined with aggressive surgical intervention and judicious withdrawal of immunosuppressants appears to be indispensable for a favorable outcome.
毛霉菌病是器官移植受者中一种机会性的、危及生命的感染。我们报告一例手术伤口毛霉菌病，其蔓延至移植肾。患者为一名59岁男性，在接受肝移植10年后接受了心脏死亡后供体肾移植。肾移植术后第10天，他出现右下腹手术伤口处皮肤和皮下组织坏死。坏死组织活检和实验室培养显示出不同病因，而聚合酶链反应迅速在物种水平鉴定出致病真菌。尽管联合治疗包括停用免疫抑制剂、静脉注射脂质体两性霉素B和积极的手术清创；但不幸的是，皮肤毛霉菌病侵犯了他的移植肾，患者接受了移植肾切除术并随后进行血液透析。我们回顾文献并得出结论，器官移植受者中的毛霉菌病是一种罕见且极其严重的并发症。聚合酶链反应为物种鉴定提供了一种快速准确的诊断技术。早期有效的抗真菌治疗联合积极的手术干预和明智地停用免疫抑制剂似乎是取得良好预后不可或缺的。
