Trichosporon fungal arteritis causing rupture of vascular anastamosis after commercial kidney transplantation: a case report and review of literature

This is a case report of a ruptured vascular anastomosis resulting from fungal arteritis in a commercial renal transplantation. The diagnosis was made quite early posttransplantation (at the 18thposttransplant day); this was proved by histopathologic examination and culture of the vessel wall,which showed Trichosporon fungal infection. The patient underwent operation for control of the bleeding and removal of the graft and of the diseased iliac vascular segment. On reviewing the literature, wefound 17 reports of fungal arteritis in solid-organ transplant recipients; our case was the first one toreport Trichosporon species as the causative agent. Infection could result from surgical or graftcontamination or from preexistent infection in the patient. There is a consensus thatthe standard of care should include removal of the graft and the diseased iliac vascular segment with anappropriate vascular graft, because simple suturing of the disrupted infected anastomosis generally ends withdisastrous recurrent rupture. A high index of suspicion is required to ensure both earlydiagnosis and appropriate treatment to prevent tragic loss of recipient life.