Mucormycosis Presented with Facial Pain in a Renal Transplant Patient: A Case Report Bayram Berktas¸ a , Hülya Tas¸ kapan a, *, Tugba Bayindir b , Uner Kayabas c , and Ismail Okan Yildirim d a Nephrology Department, Inonu University Medical Faculty, Malatya, Turkey; b Department of Otorhinolaryngology, Inonu University Medical Faculty, Malatya, Turkey; c Department of Infectious Diseases, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey; and d Radiology Department, Inonu University Medical Faculty, Malatya, Turkey ABSTRACT Introduction. Mucormycosis is a severe infection in renal transplant recipients. Here, we report a case of maxillary sinus mucormycosis in a patient who presented with a facial pain complaint. Case. A 51-year-old female patient with renal transplantation due to autosomal dominant, polycystic kidney disease and diabetic nephropathy was admitted to our hospital with facial pain and minimal edema of the left half of her face on the 8th month of transplantation. On physical examination, there was only tenderness and slight edema on the left half of the face. On the paranasal computed tomography, extensive soft tissue densities involving septations, filling the left maxillary sinus, extending to the nasal cavity, and obliterating the left osteometeal unit were observed. Because facial pain was not relieved by antibiotics and several, potent analgesic drugs on the second day, mucormycosis infection with bone involvement was suspected. A left maxillary sinus excision was performed. Microscopic examination of the debridement specimen revealed necrotic bone interspersed with fungal hyphae, and culture isolated Rhizopus oryzae. Liposomal amphotericin B was started. The patient was on tacrolimus, prednisolone, and mycophenolate mofetil. Tacrolimus was switched to cyclosporine to regulate serum glucose levels. The left maxillary sinus was washed with liposomal amphoterin B daily and curetted with intervals. The patient started dialysis because of severe renal function loss. The patient was discharged on the 96th day of liposomal amphotericin B. Conclusion. It should be kept in mind that mucormycosis may be present in the sinuses even if there is no evidence for nasal, oral, and dental examination in renal transplant patients with facial pain. I NVASIVE fungal infections can be seen in patients with solid organ transplantation. Mucormycosis is a rare, opportunistic fungal infection caused mostly by species of Rhizopus, Rhizomucor, and Cunnighamella. Seventy-five percent of the cases appear in the rhinocerebral form. Mucormycosis is more common in patients with diabetic ketoacidosis, on extensive spectrum antibiotics, and long- standing neutropenia [1]. In patients with renal trans- plantation, the rhinoorbitocerebral form is more common [2,3]. The prevalence of diabetes mellitus is 43.8% in pa- tients with mucormycosis developing after solid organ transplantation [4]. The diagnosis of mucormycosis is chal- lenging and often delayed, as the clinical presentation is not specific. Here, we report a case of sinus mucormycosis in a patient with a facial pain complaint at the 8th month of renal transplantation. CASE A 51-year-old female patient who underwent renal trans- plantation due to autosomal dominant, polycystic kidney *Address correspondence to Dr Hulya Taskapan, Inonu Uni- versity Medical Faculty, Nephrology Department, Malatya 4400, Turkey. E-mail: hulyataskapan@yahoo.com 0041-1345/19 https://doi.org/10.1016/j.transproceed.2019.02.048 ª 2019 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 2498 Transplantation Proceedings, 51, 2498e2500 (2019)