A 33-year-old male patient with a history of end-stage chronic renal failure secondary to polycystic disease.
Death donor site was established in another institution in 2007.
She received prednisone, tacrolimus and mycophenolate mofetil.
In March 2012 he underwent renal biopsy reporting acute cellular rejection Banff IA.
She was treated with methylprednisolone 1500 mg, prednisone 50 mg daily, mycophenolate 3000 mg daily and tacrolimus XL 7 mg daily.
One month later the patient developed fever, frontal and retro-ocular headache, with decreased sensitivity in the right hemisphere.
He was evaluated and diagnosed with acute sinusitis and started treatment with amoxicillin.
The patient does not improve and starts to present ocular proptosis, edema of the right upper jaw, verdosa rhinorrhea, diplopia, epiphora, palate ulcer, seizures and elevations of nitrogen.
For this reason, it is our institution.
Upon admission, the patient was febrile, with edema in the right hemisphere, extensive ulcer in the ocular proptosis, isolated palate, loss of vision due to right eye and altered renal function.
Magnetic resonance imaging of the brain showed involvement of the paranasal sinuses, right orbita, frontal lobe, sensing recesses, basal ganglia and ipsilateral thalamus area.
With these findings diagnosis of MROC is made, for which liposomal amphotericin B is initiated, immunosuppression is suspended and leads to multidisciplinary radical surgery, where sinusitis drainage, extensive gastronucleotomy of frontal bone abscess is performed.
Cultures and pathology confirmed Mucor infection.
Additionally, E. cloacae, C. sedlakii, and K pneumoniae ESBL (β-lactamase extended spectrum) were isolated.
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A magnetic resonance imaging control still shows brain disease involvement.
However, given the extension and serious sequelae of more radical surgery, it was decided to continue with medical management.
For this reason treatment was completed for 6 weeks after radical surgery with liposomal amphotericin B, meropenem, linezolid and posaconazole plus healing twice a week.
She was then discharged with posaconazole 400 mg every 12 hours, cyclosporine 50 mg every 12 hours, prednisone 5 mg daily and nutrition by gastrostomy.
Six months later the patient was in good general condition, with no signs of active infection and acceptable renal graft function (creatinine 1.5 mg/dl).
She underwent successful surgical reconstruction.
Six months after reconstruction, the patient is in good general condition and is currently undergoing facial reconstruction.
