Rhinocerebral mucormycosis in renal transplant recipients: report of three cases and review of the literature

Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales. The commonest clinical form is rhinocerebral mucormycosis, which has been described as characteristically complicating diabetes mellitus and leukemia. Three patients with rhinocerebral mucormycosis complicating renal transplantation are described, and 11 additional cases recorded in the English-language medical literature are reviewed. The mean age of the 14 patients was 36 years, and the ratio of males to females was 1.8:1. Diabetes mellitus was present in only five patients, and polycystic kidney was the most common underlying renal disease. Most kidney grafts were obtained from cadavers. Eight patients had evidence of graft rejection, and the majority had been receiving corticosteroids and azathioprine. The initial manifestations of infections became evident two days to four years after transplantation (median, two months). Facial swelling, tissue necrosis, and cranial nerve involvement were common. Seven of 14 cases occurred in Israel, a finding suggesting the intervention of local factors. Despite antifungal and/or surgical therapy, nine patients died as a consequence of the infection days to months after diagnosis. Although a rare complication, rhinocerebral mucormycosis remains a serious threat to the kidney transplant recipient.