Postrenal transplant renopulmonary zygomycosis with vascular aneurysms responded to surgical treatment and salvage therapy with posaconazole after failure to respond to liposomal amphotericin

BACKGROUND Zygomycosis is a difficult to treat and frequently fatal infection affecting immunocompromised and (rarely) immunocompetent patients. It requires a multifaceted approach involving elimination of predisposing factors, surgical debridement, and antifungal therapy. CASE REPORT We report the case of a postrenal transplant patient who developed disseminated zygomycosis with vascular aneurysms after receiving empirical voriconazole treatment for presumed pulmonary fungal infection in addition to immunosuppression and methylprednisolone pulses for presumed graft rejection, as renal biopsy was declined. Initially, liposomal amphotericin therapy in combination with surgical intervention failed. Addition of posaconazole as salvage therapy improved the patient outcome. He received total of 6 weeks of AmBisome and 12 weeks of posaconazole. CONCLUSIONS Zygomycosis is a difficult to treat infection. Management includes surgical debridement and antifungal therapy, namely liposomal amphotericin. However, in cases where treatment with liposomal amphotericin along with surgical intervention fails, posaconazole can be given as a salvage therapy. Duration of antifungal treatment should be determined on an individual basis.