Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report and review of zygomycosis in solid-organ transplant recipients.
Zygomycosis is a rare but highly invasive fungal infection that occurs in transplant recipients. We report a case of invasive gastrointestinal zygomycosis that occurred in a heavily immunosuppressed liver transplant recipient 5 days after retransplantation and that presented as gastric perforation. Despite aggressive surgical and antifungal therapy, the patient died. We review 46 cases of invasive zygomycosis in solid-organ transplant recipients. The rhinocerebral form of zygomycosis occurred in 57% of cases; the pulmonary, cutaneous, and disseminated forms each occurred in 13%; the renal form occurred in 2%; and the gastrointestinal form occurred in 2%. The infection ensued a median of 2 months after transplantation (range, 5 days to 8 years). Seventy-six percent of the patients had diabetes or had received antirejection therapy, mainly in the form of corticosteroids, before the onset of zygomycotic infection. The mortality for patients who received antifungal therapy and/or who underwent surgery was 50% for those who had rhinocerebral zygomycosis, none for those who had pulmonary and cutaneous zygomycosis, and 100% for those who had disseminated zygomycosis. Knowledge of the diverse clinical manifestations (including gastrointestinal involvement, as is illustrated by our case) and predisposing factors in transplant recipients with zygomycosis can aid in early recognition of this disease in this patient population.