jkstn The Journal of the Korean Society for Transplantation J Korean Soc Transplant 1598-1711 The Korean Society for Transplantation 10.4285/jkstn.2016.30.2.98 jkstn-30-98 Case Report Colonic Mucormycosis Mimicking Ischemic Colitis in Kidney Transplant Recipient KimHyun WooM.D. 1 YoonYoung MinM.D. 1 LeeMi JaM.D. 2 ChoiNam GyuM.D. 3 MoonSung PyoM.D. 3 YoonNa RaM.D. 1 HanSun AeM.D. 1 KimHyung NamM.D. 1 LeeJun HyungM.D. 1 KangDa YeongM.D. 1 AhnHee JungM.D. 1 ShinByung ChulM.D. 1 KimHyun LeeM.D. 1 ChungJong HoonM.D. 1 Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea Department of Internal Medicine, Pathology, Chosun University School of Medicine, Gwangju, Korea Department of Internal Medicine and Surgery, Chosun University School of Medicine, Gwangju, Korea Corresponding author: Byung Chul Shin Department of Internal Medicine, Chosun University Hospital, Chosun University School of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: 82-62-220-3967, Fax: 82-62-234-9653 E-mail: bcshin@chosun.ac.kr 012016 19012016 30298 102 23032016 18052016 26052016 Copyright © the Korean Society for Transplantation, 2016 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mucormycosis is an extremely rare but potentially life-threatening fungal infection. Mucormycosis of the gastrointestinal tract manifests with features similar to ischemic colitis. A 48-year-old man with end-stage renal disease due to diabetic nephropathy underwent deceased donor kidney transplantation. He complained of abdominal pain and distension on postoperative day 17. A computed tomography (CT) scan revealed symmetrical wall thickening of the ascending colon, which was consistent with ischemic colitis. However, a follow-up CT scan showed a localized wall-off colon perforation in the hepatic flexure and segmental mural gas in the ascending colon. Microscopic examination obtained from a surgical specimen demonstrated numerous fungal hyphae and spores in the mucosa and submucosa. A total colectomy was performed, but the patient died 36 days later due to multiple organ failure, despite antifungal agents. Clinicians should be informed about fungal infection, such as colonic mucormycosis mimicking ischemic colitis, in kidney transplant patients with diabetes mellitus, and treatment should be initiated at the earliest.

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Abdominopelvic computed tomography scan. Ascites and (A) mild to (B) moderate symmetrical wall thickening (arrows) was observed on the ascending colon.

Follow-up abdominopelvic computed tomography scan revealed (A) localized wall-off colon perforation in the hepatic flexure (hollow arrow) and (B, C) segmental mural gas in the ascending colon (arrows) and (D) symmetrical wall thickening (arrow) was observed in the descending colon.

Gross photograph of the total colectomy specimen showed necrotizing colitis from the distal transverse colon to the descending colon.

Colon pathologic findings. (A) Numerous fungal hyphae and spores are noted in the mucosa and submucosa (arrows) (HE stain, ×200). (B, C, D) Fungal organisms are characterized by large non-septated hyphae with acute angle branching (B: HE stain, ×400; C: PAS, ×400; D: Gomori methenamine silver, ×400).