J Korean Soc Transplant.  2016 Jun;30(2):98-102. 10.4285/jkstn.2016.30.2.98.

Colonic Mucormycosis Mimicking Ischemic Colitis in Kidney Transplant Recipient

Affiliations
  • 1Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea. bcshin@chosun.ac.kr
  • 2Department of Pathology, Chosun University School of Medicine, Gwangju, Korea.
  • 3Department of Surgery, Chosun University School of Medicine, Gwangju, Korea.

Abstract

Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Mucormycosis of the gastrointestinal tract manifests with features similar to ischemic colitis. A 48-year-old man with end-stage renal disease due to diabetic nephropathy underwent deceased donor kidney transplantation. He complained of abdominal pain and distension on postoperative day 17. A computed tomography (CT) scan revealed symmetrical wall thickening of the ascending colon, which was consistent with ischemic colitis. However, a follow-up CT scan showed a localized wall-off colon perforation in the hepatic flexure and segmental mural gas in the ascending colon. Microscopic examination obtained from a surgical specimen demonstrated numerous fungal hyphae and spores in the mucosa and submucosa. A total colectomy was performed, but the patient died 36 days later due to multiple organ failure, despite antifungal agents. Clinicians should be informed about fungal infection, such as colonic mucormycosis mimicking ischemic colitis, in kidney transplant patients with diabetes mellitus, and treatment should be initiated at the earliest.

Keyword

Mucormycosis; Kidney transplantation; Ischemic colitis

MeSH Terms

Abdominal Pain
Antifungal Agents
Colectomy
Colitis, Ischemic*
Colon*
Colon, Ascending
Diabetes Mellitus
Diabetic Nephropathies
Follow-Up Studies
Gastrointestinal Tract
Humans
Hyphae
Kidney Failure, Chronic
Kidney Transplantation
Kidney*
Middle Aged
Mucormycosis*
Mucous Membrane
Multiple Organ Failure
Spores
Tissue Donors
Tomography, X-Ray Computed
Transplant Recipients*
Antifungal Agents

Figure

  • Fig. 1. Abdominopelvic computed tomography scan. Ascites and (A) mild to (B) moderate symmetrical wall thickening (arrows) was observed on the ascending colon.

  • Fig. 2. Follow-up abdominopelvic computed tomography scan revealed (A) localized wall-off colon perforation in the hepatic flexure (hollow arrow) and (B, C) segmental mural gas in the ascending colon (arrows) and (D) symmetrical wall thickening (arrow) was observed in the descending colon.

  • Fig. 3. Gross photograph of the total colectomy specimen showed necrotizing colitis from the distal transverse colon to the descending colon.

  • Fig. 4. Colon pathologic findings. (A) Numerous fungal hyphae and spores are noted in the mucosa and submucosa (arrows) (HE stain, ×200). (B, C, D) Fungal organisms are characterized by large non-septated hyphae with acute angle branching (B: HE stain, ×400; C: PAS, ×400; D: Gomori methenamine silver, ×400).


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