Pulmonary mucormycosis after heart transplantation: an uncommon case report

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d2863153e159"> <!-- named anchor --> </a> <h5 class="section-title" id="d2863153e160">Background:</h5> <p dir="auto" id="d2863153e162">Mucormycosis (MCR) is an uncommon but frequently deadly fungal infection that typically affects individuals with weakened immune systems. Pulmonary MCR, in particular, is most frequently observed in patients who have undergone stem cell or solid organ transplants. The incidence of MCR in solid organ transplant recipients is reported to be 0.07% within the first year. In almost 40% of these transplant patients, including the case we examined, the infection is diagnosed within the first 6 months after the transplant. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d2863153e164"> <!-- named anchor --> </a> <h5 class="section-title" id="d2863153e165">Case Presentation:</h5> <p dir="auto" id="d2863153e167">We report a rare case of a 67-year-old man who developed pulmonary MCR within 6 months after undergoing a heart transplant. A bronchoscopy was conducted, and Reverse transcription polymerase chain reaction along with cultures of the broncho-alveolar samples tested positive for Mucorales. After consulting with experts from thoracic and vascular surgery, cardiology, pulmonology, and microbiology, and adhering to the expert guidelines, a semi-urgent source control procedure was recommended. This involved performing a thoracoscopic exploration of the right pleura, which was subsequently converted to a lateral thoracotomy, culminating in the resection of the right lower lobe. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d2863153e169"> <!-- named anchor --> </a> <h5 class="section-title" id="d2863153e170">Conclusion:</h5> <p dir="auto" id="d2863153e172">Invasive MCR is a rare but serious fungal infection with a high risk of illness and death, particularly in people with underlying health issues or weakened immune systems. The clinical and imaging manifestations can vary among patients based on their immune status and how they contracted the infection. Despite these variations, it is vital to maintain a high level of suspicion for MCR, as early diagnosis and the rapid initiation of surgical and antifungal treatments are critical for improving survival chances. </p> </div>