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Case Reports
. 2016 Feb 12:2016:bcr2015214097.
doi: 10.1136/bcr-2015-214097.

Fulminant zygomycosis of graft liver following liver transplantation

Pulkit Sethi  1 , Dinesh Balakrishnan  1 , Sudhindran Surendran  1 , Zubair Umer Mohamed  2
Affiliations
Case Reports

Fulminant zygomycosis of graft liver following liver transplantation

Pulkit Sethi et al. BMJ Case Rep. .

Abstract

A 44-year-old man with hepatitis B virus (HBV)-related cirrhosis underwent living donor liver transplantation at our institute. Induction of immunosuppression was achieved with basiliximab, due to deranged renal function, and maintained with prednisolone, tacrolimus and mycophenolate mofetil. The intraoperative and immediate postoperative periods were fairly uneventful. A duplex scan, taken during the third week post-transplantation due to sudden rise in liver enzymes, revealed multifocal hypoechoic lesions in the graft liver with normal Doppler parameters. Multidetecor computed tomography (MDCT) showed multiple hypodense vessel-sparing lesions in the graft liver. Cultures from the aspirate grew filamentous fungi identified as Basidiobolus ranarum species. Despite multiple broad spectrum antifungal infusions including liposomal amphotericin, itraconazole, caspofungin and posaconazole, serial sonography showed the hepatic lesions increasing in size, and involving segments V, VI and VII. The patient developed severe liver dysfunction ultimately progressing to sepsis, multiorgan dysfunction and death.

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Figures

Figure 1
Figure 1
CT image showing multifocal lesions in the graft liver.
Figure 2
Figure 2
Microscopic image of the fungus, Basidiobolus ranarum.
See this image and copyright information in PMC

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