{"title":"Disseminated Cunninghamella bertholletiae Infection From Latent Lower Limb Mass After Kidney Transplant: A Case Report","authors":"Yadi Wang, Keqin Zhang, Ling Liu, Runtian Qu","doi":"10.1016/j.transproceed.2025.03.032","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Cunninghamella <em>bertholletiae</em> (C. <em>bertholletiae</em><span><span>), a rare yet highly virulent species within the Mucorales order, predominantly affects individuals with compromised immune systems. Disseminated infections caused by this </span>pathogen<span><span> frequently lead to severe complications, underscoring the necessity for prompt diagnosis and aggressive therapeutic interventions. Invasive fungal diseases (IFDs) continue to be a major cause of morbidity and mortality among </span>kidney transplant<span> recipients, characterized by elevated incidence and mortality rates. The early and precise identification of fungal pathogens is crucial for optimizing patient outcomes.</span></span></span></div></div><div><h3>Case presentation</h3><div>This report presents a case study of a 37-year-old male kidney transplant recipient who developed a disseminated C. <em>bertholletiae</em><span><span><span> infection from a latent lower limb lesion. Initially, he showed symptoms of high fever and dyspnea, leading to diagnoses of sepsis<span><span>, severe pneumonia, acute respiratory distress syndrome, and </span>allograft dysfunction. After surgery, he had recurrent </span></span>pleural effusion and worsening </span>pulmonary nodules. Metagenomic next-generation sequencing (mNGS) confirmed C. </span><em>bertholletiae</em><span> infection, and histopathology<span> revealed mucormycosis with vascular invasion, thrombosis, and tissue necrosis<span><span>. The patient underwent a 13-month antifungal treatment with </span>amphotericin B lipid complex<span><span>, posaconazole, and </span>isavuconazole.</span></span></span></span></div></div><div><h3>Conclusion</h3><div><span>This case highlights the essential role of histopathology and mNGS in early detection of rare IFDs and stresses the need for a multidisciplinary approach combining surgery with antifungal therapy. The effective management of disseminated C. </span><em>bertholletiae</em><span><span> infection using a triple antifungal regimen offers important insights for future cases, underscoring the importance of early diagnosis and personalized treatment in </span>immunocompromised patients.</span></div></div>","PeriodicalId":23246,"journal":{"name":"Transplantation proceedings","volume":"57 7","pages":"Pages 1319-1324"},"PeriodicalIF":0.8000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation proceedings","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0041134525002350","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
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Abstract
Background
Cunninghamella bertholletiae (C. bertholletiae), a rare yet highly virulent species within the Mucorales order, predominantly affects individuals with compromised immune systems. Disseminated infections caused by this pathogen frequently lead to severe complications, underscoring the necessity for prompt diagnosis and aggressive therapeutic interventions. Invasive fungal diseases (IFDs) continue to be a major cause of morbidity and mortality among kidney transplant recipients, characterized by elevated incidence and mortality rates. The early and precise identification of fungal pathogens is crucial for optimizing patient outcomes.
Case presentation
This report presents a case study of a 37-year-old male kidney transplant recipient who developed a disseminated C. bertholletiae infection from a latent lower limb lesion. Initially, he showed symptoms of high fever and dyspnea, leading to diagnoses of sepsis, severe pneumonia, acute respiratory distress syndrome, and allograft dysfunction. After surgery, he had recurrent pleural effusion and worsening pulmonary nodules. Metagenomic next-generation sequencing (mNGS) confirmed C. bertholletiae infection, and histopathology revealed mucormycosis with vascular invasion, thrombosis, and tissue necrosis. The patient underwent a 13-month antifungal treatment with amphotericin B lipid complex, posaconazole, and isavuconazole.
Conclusion
This case highlights the essential role of histopathology and mNGS in early detection of rare IFDs and stresses the need for a multidisciplinary approach combining surgery with antifungal therapy. The effective management of disseminated C. bertholletiae infection using a triple antifungal regimen offers important insights for future cases, underscoring the importance of early diagnosis and personalized treatment in immunocompromised patients.
期刊介绍:
Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication.
The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics.
Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board.
Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.