Case report Invasive zygomycosis in transplant recipients The Zygomycetes fungi belong to the Mucorales family that includes several subgroups such as Rhizopus spp., Absidia spp., Cunninghamella spp., or Rhizomucor spp. Zygomycosis is an opportun- istic infection principally seen in patients with hematologic malignancies, diabetic ketoacidosis, neutropenia, iron chelation with deferoxamine, and trauma (1). As a complication of long-term immunosuppression in transplant recipients pub- lished cases of zygomycosis have been limited so far to 44 bone marrow transplant (BMT) (2) and 116 solid organ transplant recipients (3). Clinical presentations include rhino-sino-orbital, rhinocer- ebral, pulmonary, gastrointestinal, and cutaneous infections (2). Deep tissue invasion with dissemin- ated disease occurs in the case of delayed diagnosis. Mortality is high, and depends on the possibility to reduce the immunosuppression, and to combine surgical resection of infected tissue with a specific antifungal treatment (1). We have recently seen two cases of zygomycosis among our transplant recipients with very different clinical presentations. In order to determine the clinical features of this infection in our transplant recipient population we retrospectively reviewed the microbiological database of our Central Bac- teriology Laboratory from 1989 till October 2004. Four cases of invasive zygomycosis in transplant recipients were identified and are presented in the light of the present literature (Table 1). Case reports Case report 1 Aplastic anemia was diagnosed in a 40-yr-old female patient in summer 2002. The initial immunosup- pressive therapy consisted in ciclosporine (CSA), antithymocyte globulin (ATG) and prednisone. Deferoxamine was introduced to prevent secondary Uc¸kay I, Chalandon Y, Sartoretti P, Rohner P, Berney T, Hadaya K, van Delden C. Invasive zygomycosis in transplant recipients. Clin Transplant 2007: 21: 577–582. ª Blackwell Munksgaard, 2007 Abstract: Zygomycosis are rare fungal infections occurring mainly in im- munocompromised patients. To date only 160 cases have been published in transplant recipients. We report four new cases of zygomycosis in transplant recipients illustrating the large clinical spectrum of this infection: one dis- seminated infection with heart involvement and one rhinocerebral infection with dissemination in two bone marrow transplant recipients, one cutane- ous infection in a liver and one pulmonary infection in a kidney recipient. All cases, except the cutaneous infection that was accessible to surgical resection and a systemic antifungal treatment, were fatal. In transplant recipients cumulating risk factors for zygomycosis, a high index of suspicion is required. Early diagnosis and combining surgery with systemic ampho- tericin-B are mandatory to improve survival rates. Ilker Uc ¸kay a , Yves Chalandon b , Pascal Sartoretti c , Peter Rohner d , Thierry Berney e , Karine Hadaya f and Christian van Delden a,e a Service of Infectious Diseases, b Service of Haematology, c Department of Pathology, d Central Laboratory of Bacteriology, e Service of Transplantation, and f Service of Nephrology, University Hospital of Geneva, Geneva, Switzerland Key words: rhizomucor – rhizopus – transplantation – zygomycosis Corresponding author: Christian van Delden, Service of Transplantation, Department of Surgery, University Hospital of Geneva, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. Tel.:+41 22 372 3207; fax: +41 22 372 9830; e-mail: christian.vandelden@hcuge.ch Accepted for publication 5 March 2007 Clin Transplant 2007: 21: 577–582 DOI: 10.1111/j.1399-0012.2007.00684.x Copyright ª Blackwell Munksgaard 2007 577