Case Report: Intra-abdominal Mucormycosis Diagnosed at the Time of Liver Transplantation for Surgically Induced Acute Liver Failure.

Mucormycosis is an aggressive fungal infection associated with high mortality, particularly among recipients of solid organ transplants. Gastrointestinal involvement is rare but can be fatal due to delayed diagnosis and limited therapeutic options. We report on a 59-year-old female who developed intra-abdominal mucormycosis that was diagnosed during orthotopic liver transplantation. She initially presented with a perforated duodenal ulcer requiring emergent surgical repair and subsequently developed acute liver failure due to an iatrogenic transection of the portal triad. She underwent urgent orthotopic liver transplantation and was found to have multiple gastric ulcers. Tissue biopsies from the stomach and abdomen revealed broad, nonseptate hyphae consistent with Mucorales, which was later identified as Mucor circinelloides. Postoperatively, she required eight reexplorations with extensive debridement and amphotericin B irrigation of the abdominal cavity. She received systemic antifungal therapy with liposomal amphotericin B and azoles guided by susceptibility testing. Immunosuppression was minimized, with tacrolimus maintained at low trough levels and a rapid corticosteroid taper. Fungal cultures cleared up 25 days posttransplant. She completed 6 months of antifungal therapy and remains free from infection with excellent graft function at 1 year. This case underscores the importance of early diagnosis of intra-abdominal mucormycosis and highlights that aggressive surgical debridement, tailored antifungal therapy, and careful immunosuppression management are essential to achieving a successful outcome.