Dual Invasive Fungal Infections After Kidney Transplantation: A Case Report

Donor-derived infections (DDIs), particularly fungal DDIs, are uncommon but serious complications of solid organ transplantation. We report a case of a 52-year-old woman who underwent deceased donor kidney transplantation complicated by probable donor-derived Candida albicans candidemia with native aortic valve endocarditis, managed medically with prolonged echinocandin therapy followed by suppressive fluconazole. Approximately 14 months post-transplant, she developed progressive rhino-orbital mucormycosis due to Rhizopus oryzae, requiring extensive surgical debridement and prolonged antifungal therapy. Initial treatment with liposomal amphotericin B was limited by nephrotoxicity, prompting transition to isavuconazole for long-term management. Immunosuppression was discontinued to control infection, resulting in graft failure. This case illustrates the complex interplay between donor-derived infection, antifungal exposure, and immunosuppression in transplant recipients. It highlights the potential contribution of antifungal selective pressure to breakthrough mold infections and underscores the importance of early recognition, aggressive multidisciplinary management, and individualized antifungal strategies in this high-risk population.