Early onset of pulmonary mucormycosis with pulmonary vein thrombosis in a heart transplant recipient

Pulmonary infections are major complications in heart transplantation. Progress in antimicrobial chemotherapy has switched the clinical spectrum to an increased incidence of fungal pathogens, such as Candida and Aspergillus species. Mucormycosis is a rare opportunistic infection with high mortality in solid-organ transplant recipients usually ensuing several months after transplantation. We describe a 45-year-old patient with pulmonary mucormycosis manifestion 5 days after heart transplantation. The infection resulted in pulmonary vein thrombosis followed by hemorrhagic infarction. Despite antifungal treatment and surgical resection, the patient died on day 14 after transplantation. Antemortem diagnostic procedures were negative; autopsy confirmed the presence of Rhizopus oryzae invading blood vessels. We conclude that physicians must be aware of mucormycosis even within one week after heart transplantation-which has not been described so far. Invasive diagnostic workup is mandatory in case of suspicion; amphotericin B and, in selected cases, surgical resection are the mainstays of therapy.