MUCORMYCOSIS IN LUNG TRANSPLANTATION

Abstract

Mucormycosis is the 3rd most common cause of invasive fungal infection, after candidiasis and aspergillosis. The reported incidence is 1,5% in lung transplantation. The initial suspicion is based on the signs and symptoms presented, which vary according to the form of the disease: 1-rhinocerebral, 2- pulmonary, 3- cutaneous, 4- gastrointestinal and 5- disseminated. The presence of a necrotic ulcer with blackened eschar (cutaneous or mucosal) is a characteristic lesion and should be considered a warning sign in at-risk patients. Computed tomography and magnetic resonance imaging are used to identify injuries and assess the extent of involvement. Histopathology and culture are essential for diagnosis. In the reported case, treatment consisted of extensive surgical debridement and administration of antifungals, including topical amphotericin B and intravenous liposomal amphotericin B.  Posaconazole, indicated as rescue therapy and associated with success rates of approximately 60%, was added. VAC (Vacuum Assisted Closure) dressings on the debrided areas were performed as well as hyperbaric oxygen therapy. The outcome was unfavorable.