A69-15 Pulmonary Mucormycosis in Heart Transplant Patient With Retained Foreign Body: A Case Study

Introduction Necrotizing pulmonary mucormycosis is a rare, life-threatening opportunistic fungal infection affecting profoundly immunocompromised patients, such as solid organ transplant recipients or those with uncontrolled diabetes. It is caused by ubiquitous Mucorales species, with Rhizopus being the most common etiology. Diagnosis requires a high index of suspicion, and management involves aggressive surgical debridement and systemic antifungal therapy, often with poor outcomes despite optimal treatment. We describe a complex and rare case of necrotizing pulmonary mucormycosis in a heart transplant recipient in whom a retained right ventricular AICD electrode fragment may have acted as an infectious nidus. Case Presentation A 55-year-old male with a history of type 2 diabetes mellitus, end-stage renal disease, and nonischemic cardiomyopathy received an orthotopic heart transplant. He presented with cough, dizziness, and nausea, showing fever and sinus tachycardia. Labs revealed severe hyperglycemia without ketoacidosis, consistent with hyperosmolar hyperglycemic syndrome. A chest radiograph showed a soft tissue density in the right basilar region, a foreign body determined to be the retained shock coil from a prior implantable cardioverter-defibrillator lead. Echocardiogram showed large pericardial effusion requiring drainage. Despite empirical antibiotic and antifungal therapy (cefepime, fluconazole, atovaquone, valacyclovir, then piperacillin/tazobactam, and micafungin), the fever and leukocytosis persisted. Serial radiographs confirmed a right basilar consolidation, and a follow-up chest CT revealed a right lower lobe (RLL) dense consolidation with central necrosis and localized pleural effusion. Diagnostic procedures revealed exudative fluid with negative cultures, though subsequent bronchoscopy and thoracentesis samples grew Rhizopus zygomycosis/mucormycosis. The patient ultimately underwent RLL lobectomy with pathology confirming the diagnosis and was initiated on lifelong Posaconazole. Discussion and Conclusion Necrotizing pulmonary mucormycosis in heart transplant recipients is driven by a complex interplay of risk factors. Profound immunosuppression, diabetes mellitus, and renal failure are consistently identified as major contributors to susceptibility, with renal replacement therapy and allograft rejection further increasing risk. In this context, retained cardiovascular implantable electronic device segments, such as ICD leads, may act as a local nidus for infection, but current evidence does not support a direct causal relationship. Instead, device-related hardware should be considered a possible additive risk, compounding the effects of traditional factors. The absence of consensus guidelines regarding management of retained leads underscores the need for individualized assessment. This case illustrates the importance of early recognition and aggressive intervention, as outcomes remain poor despite optimal therapy. Vigilance for invasive fungal infections and risk mitigation are essential in patients with organ transplants.