Yu-An Chen, Chia-Hui Chou, Mao-Wang Ho
Background
Fungi
of the order Mucorales are ubiquitous in nature but rarely cause human
infection. However, because of the rising amount of immunocompromised patients,
the incidence of invasive fungal infection also increased. There was only one
case report of pleural empyema related to mucormycosis to date. Here we report
the first case in Taiwan and review the literature of the previous reports.
Methods
A
54-year-old man with a history of end stage diabetic nephropathy presented to
our hospital 35 days after receiving kidney transplantation, complaining
progressive dyspnea and pleuritic right chest pain for 5 days. The initial laboratory
data showed leukocytosis (WBC 16,200 cells/ micro liter) and chest plain film
showed right side ill-defined opacity with pleural effusion. Broad-spectrum
antibiotic was initiated but the clinical improvement was limited. The pleural
effusion Gram’s stain and further analysis yielded mold of Rhizopus species.
Results
Pig-tail
was inserted for pleural effusion drainage, and we started Liposomal
Amphotericin B for mold of Rhizopus species. Fever subsided and the respiratory
condition also improved. The pig-tail was removed 40 days later when the
drainage amount decreased to 30 ml. Liposomal Amphotericin B was discontinued
after 25 days of therapy, and was shifted to oral Posaconazole for maintenance.
Currently the patient is doing well and received regular follow-up in our
outpatient clinic.
Conclusions
The
advance of solid organ or hematologic stem cell transplantation, improvement of
survival in patients with hematologic malignancy, and the increasing number of
HIV-infected patients all contributed the enlarged number of immunocompromised
patient. And the number of previously rarely, opportunistic infection will rise
with time. Obtain the adequate sample and make the right diagnosis will reverse
the potentially life-threatening infection of the patients and is of paramount
importance to achieve long-term survival in these patients.
