A 39-year-old male patient with hypertension and chronic kidney disease on maintenance hemodialysis through a permanent dialysis catheter received an ABO-incompatible deceased donor renal transplant. The graft was harvested in another city and transported to our institution. He received antithymocyte globulin and methylprednisolone in addition to standard triple immunosuppression. One week later, he developed rising creatinine that was attributed to rejection and received methylprednisolone. However, renal biopsy alarmingly showed findings of mucormycosis. Graft nephrectomy, along with surrounding debridement, was carried out. Histopathology of the graft revealed abundant mucoralean hyphae involving all compartments of the renal parenchyma: blood vessels, glomerular capillaries, Bowman’s capsule, tubules, and interstitium, as shown by Grocott–Gomori methenamine staining in the cover image. These findings may indicate a contaminated perfusing solution as the source of infection. Treatment with liposomal amphotericin B was initiated, but was soon changed to isavuconazole. Culture revealed a mould that was identified as Rhizopus species by morphology, but MS Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF) could not identify the organism, perhaps indicating that it was an unusual environmental species. The case underscores the need for strict aseptic practices throughout the transplantation process, vigilance for graft infections, and timely diagnostics by biopsy and appropriate surgical and medical therapy. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Kakde et al. (Thu,) studied this question.