Rhinocerebral Zygomycosis After Liver Transplantation: Therapeutic Challenges in Recipients Treated for Recurrent Hepatitis C

INTRODUCTION T he susceptibility of immunosuppressed solid organ hosts to opportunistic infections is well recognized. However, recipients of liver transplants done for hepatitis C virus (HCV)-related cirrhosis, currently the most common indication for liver transplantation in the United States, face unique additional challenges (1). Their resistance to opportunistic infections may be lowered even further due to (I) posttransplant diabetes, a frequent metabolic complication observed in up to 60% of those recipients (2), (II) varying degrees of chronic renal insufficiency (from HCVassociated membranoproliferative and other forms of glomerulonephritis), which can be worsened by use of calcineurin inhibitors (3), and (III) adverse side effects of the therapy of recurrent HCV infection (e.g., neutropenia, anemia). We illustrate these challenges in a report on one of our recipients who developed a usually highly fatal rhinocerebral zygomycosis while undergoing combination therapy with interferon and ribavirin for recurrent hepatitis C. A CASE TO REMEMBER