ABSTRACT
Mucormycosis is an uncommon opportunistic fungal infection with high mortality in liver transplant recipients. Mucormycosis of the gastrointestinal tract can manifest with features similar to ischemic colitis. Typically signs and symptoms of non-gangrenous ischemic colitis resolve spontaneously within 24-48 h. On the other hand, the clinical course of the mucormycosis is commonly fulminant. We encountered a case of invasive fungal colitis presenting with abdominal pain and hematochezia in a liver transplant recipient. Endoscopic examination showed multiple shallow ulcerations and edema with mucosal friabilities on the sigmoid and distal descending colon, which was consistent with ischemic colitis. However, the histological examination obtained from endoscopic biopsies showed fungal hyphae with surrounding inflammatory cells and mucosal necrosis. The patient was successfully managed with antifungal agent without surgical treatment. Thus, early diagnosis and treatment is essential for improving the prognosis of invasive fungal infection after liver transplantation.
Subject(s)
Colitis, Ischemic/etiology , Liver Transplantation/adverse effects , Mucormycosis/etiology , Opportunistic Infections/etiology , Abdominal Pain/etiology , Adult , Antifungal Agents/therapeutic use , Biopsy , Colitis, Ischemic/diagnosis , Colonoscopy , Early Diagnosis , Gastrointestinal Hemorrhage/etiology , Humans , Male , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/microbiology , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Predictive Value of Tests , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Massive deposits of fat around heart are seen in overweight persons and are associated with coronary artery disease. Investigators have focused on the clinical significance of epicardial fat with respect to metabolic effects such as insulin resistance and inflammation, but the mechanical effects, such as constriction, have been largely ignored. We present an unusual case of a 59-year-old woman with obesity and diabetes mellitus who had been undergoing peritoneal dialysis due to end-stage renal disease, and who developed constrictive pericarditis, possibly secondary to extensive epicardial fatty accumulation.
