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Invasive gastric mucormycosis and cytomegalovirus infection in an ABO incompatible renal transplant recipient.

Nandwani A, Jha PK, Duggal R, Kher V - Indian J Nephrol (2015 Nov-Dec)

Bottom Line: Cytomegalovirus (CMV) remains one of the most important pathogens.Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy.The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Haryana, India.

ABSTRACT
Opportunistic infections are common in immunocompromised patients, such as solid organ transplant recipients. Both fungal and viral infections in posttransplant period increase morbidity and mortality. Cytomegalovirus (CMV) remains one of the most important pathogens. CMV disease may manifest as a nonspecific febrile syndrome or tissue-invasive infections. Zygomycosis is a rare infection, usually presents in rhino-cerebral, pulmonary and disseminated forms; gastrointestinal (GI) tract being a rare site of involvement. Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy. We report a renal transplant recipient, who developed gastric mucormycosis along with tissue invasive CMV disease, within 4 weeks of renal transplant and was diagnosed on the basis of upper GI endoscopy and gastric biopsy. The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy.

No MeSH data available.


Related in: MedlinePlus

(a) Higher magnification reveals broad nonseptate mucor hyphae (original magnification, H and E, ×40). (b) grocotts stain reveals gastric mucosal epithelial fragment at the lower end and necrotic suppurative exudate at the upper end (original magnification, Grocotts, ×4). (c) Higher magnification of the necrotic area reveals broad nonseptate hyphae of mucormycosis (original magnification, Grocotts, ×40). (d) Cytomegalovirus (CMV) immunostain shows nuclear positivity in the affected cytomegalic cells (original magnification, CMV IHC, ×20)
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Figure 1: (a) Higher magnification reveals broad nonseptate mucor hyphae (original magnification, H and E, ×40). (b) grocotts stain reveals gastric mucosal epithelial fragment at the lower end and necrotic suppurative exudate at the upper end (original magnification, Grocotts, ×4). (c) Higher magnification of the necrotic area reveals broad nonseptate hyphae of mucormycosis (original magnification, Grocotts, ×40). (d) Cytomegalovirus (CMV) immunostain shows nuclear positivity in the affected cytomegalic cells (original magnification, CMV IHC, ×20)

Mentions: In view of recurrent vomiting, upper GI endoscopy was done, which revealed deep, round punched out hemorrhagic ulcerations involving the esophagus and corpus of the stomach along with necrotic-ulcerative lesions involving the lesser curvature of the stomach. Gastric biopsy from the involved regions revealed broad, nonseptate hyphae with right angled branching on sections stained with H and E and grocotts stain, suggestive of mucormycosis [Figure 1]. Also, there was evidence of intranuclear inclusion bodies in gastric mucosa suggestive of CMV gastritis, which was confirmed by immunohistochemistry [Figure 1]. Blood CMV viral load was 2200 copies/ml.


Invasive gastric mucormycosis and cytomegalovirus infection in an ABO incompatible renal transplant recipient.

Nandwani A, Jha PK, Duggal R, Kher V - Indian J Nephrol (2015 Nov-Dec)

(a) Higher magnification reveals broad nonseptate mucor hyphae (original magnification, H and E, ×40). (b) grocotts stain reveals gastric mucosal epithelial fragment at the lower end and necrotic suppurative exudate at the upper end (original magnification, Grocotts, ×4). (c) Higher magnification of the necrotic area reveals broad nonseptate hyphae of mucormycosis (original magnification, Grocotts, ×40). (d) Cytomegalovirus (CMV) immunostain shows nuclear positivity in the affected cytomegalic cells (original magnification, CMV IHC, ×20)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663777&req=5

Figure 1: (a) Higher magnification reveals broad nonseptate mucor hyphae (original magnification, H and E, ×40). (b) grocotts stain reveals gastric mucosal epithelial fragment at the lower end and necrotic suppurative exudate at the upper end (original magnification, Grocotts, ×4). (c) Higher magnification of the necrotic area reveals broad nonseptate hyphae of mucormycosis (original magnification, Grocotts, ×40). (d) Cytomegalovirus (CMV) immunostain shows nuclear positivity in the affected cytomegalic cells (original magnification, CMV IHC, ×20)
Mentions: In view of recurrent vomiting, upper GI endoscopy was done, which revealed deep, round punched out hemorrhagic ulcerations involving the esophagus and corpus of the stomach along with necrotic-ulcerative lesions involving the lesser curvature of the stomach. Gastric biopsy from the involved regions revealed broad, nonseptate hyphae with right angled branching on sections stained with H and E and grocotts stain, suggestive of mucormycosis [Figure 1]. Also, there was evidence of intranuclear inclusion bodies in gastric mucosa suggestive of CMV gastritis, which was confirmed by immunohistochemistry [Figure 1]. Blood CMV viral load was 2200 copies/ml.

Bottom Line: Cytomegalovirus (CMV) remains one of the most important pathogens.Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy.The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Haryana, India.

ABSTRACT
Opportunistic infections are common in immunocompromised patients, such as solid organ transplant recipients. Both fungal and viral infections in posttransplant period increase morbidity and mortality. Cytomegalovirus (CMV) remains one of the most important pathogens. CMV disease may manifest as a nonspecific febrile syndrome or tissue-invasive infections. Zygomycosis is a rare infection, usually presents in rhino-cerebral, pulmonary and disseminated forms; gastrointestinal (GI) tract being a rare site of involvement. Newer techniques for early diagnosis and efficient therapies are essential for a better outcome of the disease; however, mortality rate remains high despite aggressive therapy. We report a renal transplant recipient, who developed gastric mucormycosis along with tissue invasive CMV disease, within 4 weeks of renal transplant and was diagnosed on the basis of upper GI endoscopy and gastric biopsy. The patient succumbed to the infection in spite of gastrectomy, antifungal and antiviral therapy.

No MeSH data available.


Related in: MedlinePlus