Cerebral mucormycosis after liver transplantation: a case report

A fatal case of cerebral mucormycosis occurring shortly after liver transpl antation is described. The patient was a 32-yr-old male with advanced end-s tage liver disease manifested by tense ascites, spontaneous bacterial perit onitis, deepening jaundice and anuria requiring hemodialysis. The 3rd day a fter successful liver transplantation the patient developed acute respirato ry failure, then focal motor signs. Computed tomography showed fluid in the left maxillary sinus, partial opacification of the ethmoid and sphenoid si nuses, and diffuse low density lesions in both cerebral hemispheres. Despit e treatment for cerebritis and cerebral edema, the patient's pupils became fixed and dilated, and brain death was declared. Autopsy revealed mucor sin usitis and cerebritis. Mucormycosis is an opportunistic fungal infection occurring in patients wit h diabetic ketoacidosis, malignancy, or immunodeficiency, and in those rece iving wide-spectrum antibiotics, corticosteroids, or cytotoxic therapy. Muc or most frequently involves the face, rhinocerebral disease predominating. These infections are difficult to treat, but are curable with aggressive an d frequent surgical debridement, discontinuation or reduction of immunosupp ressive therapy and amphotericin. The diagnosis of mucormycosis is very dif ficult to make in cases such as the present one, in which the typical prese ntation and classical signs are not present. A high index of suspicion base d on identified risk factors may assist in more rapid diagnosis of this lif e-threatening mycosis.