CAVITATORY LUNG RHIZOPUS INFECTION IN RENAL TRANSPLANT RECIPIENT: RARE CASE REPORT

ABSTRACT

Introduction: Mucormycosis is a life threatening fungal infection commonly seen in diabetics and immunocompromised individuals. It is caused by one of the members of mucoraceae family which includes mucor, rhizopus, rhizomucor, absidia and others. Its prevalence has become more common in covid pandemic. Methods: We report a rare case of large cavitatory Rhizopus infection in a renal transplant recipient. Patient was initiated on antitubercular therapy for tubercular lymphadenitis two months prior to transplant. He was given rabbit ATG as induction agent and was on triple maintenance immunosuppression with tacrolimus/ mycophenolate mofetil/ steroids. Patient developed post transplant Diabetes mellitus. Four months post transplant he presented with cough, fever and left sided chest and shoulder pain for 10 days. Covid RT PCR was done twice and it came out to be negative. High Resolution Computed tomography Chest revealed thick walled cavity abutting the chest wall (10.3 x 7.1cm) in left upper lobe. Blood culture was sterile after five days of incubation. Serum Beta galactomannan was negative. He was empirically started on broad spectrum antibiotics and antifungals (oral voriconazole). He underwent bronchoscopy on day 4 of admission. As tuberculosis was a differential, gene expert, tubercular culture and AFB stain was obtained on Bronchoalveolar(BAL) fluid which all came out to be negative. Microbiological sample from BAL Fluid revealed growth of Rhizopus species. He was started on Liposomal amphotericin B. Since the cavitatory lesion occupied almost the entire left lung, surgical resection was offered to the patient to which patient refused. Results: He improved symptomatically after 10 days of Liposomal amphotericin B. Total of 10 weeks of Liposomal amphotericin B was given. Follow up CT after 40 days showed significant reduction in size of cavity to 7.5cm. A surprising complete resolution of the lung cavity was seen after 4 months. Conclusions: This case is one of the very few reported cases of invasive pulmonary rhizopus infections. It emphasizes how medical treatment alone can lead to complete resolution of such large cavitatory lesions without surgical intervention. No conflict of interest