Mucormycosis is a virulent angioinvasive fungal infection that predominantly affects immunocompromised individuals, particularly solid organ transplant recipients. Although infrequent, its manifestation in renal transplant recipients correlates with significant morbidity and death because of fast progression, vascular involvement, and diagnostic delays. We present a 36-year-old male renal transplant recipient who presented with the complaints of right-sided flank pain, erythema at the graft site, oliguria, and hematuria. His previous treatment was punctuated by repeated urological procedures for vesicoureteral stricture, necessitating repeated double-J stent replacements. Computed tomography Imaging revealed graft pyelonephritis, accompanied by hydronephrosis, following which graft percutaneous nephrostomy was done. For the suspicion of rejection, the patient underwent renal biopsy, which was suggestive of renal cortical necrosis with mucormycosis. He was started on liposomal amphotericin B and micafungin. Renal Doppler was done, which revealed no flow in renal vessels. Following this, the patient was taken up for conventional renal angiography, which revealed right internal iliac artery thrombosis. Balloon angioplasty was attempted but was unsuccessful. The following day, he underwent graft nephrectomy. The patient eventually succumbed to death. Renal mucormycosis in transplant recipients constitutes a medical emergency linked to unfavorable prognosis. Prompt identification, immediate commencement of antifungal treatment, and surgical intervention are essential.
Malde et al. (Thu,) studied this question.