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Invasive Microascus trigonosporus Species Complex Pulmonary Infection in a Lung Transplant Recipient.

Schoeppler KE, Zamora MR, Northcutt NM, Barber GR, O'Malley-Schroeder G, Lyu DM - Case Rep Transplant (2015)

Bottom Line: Because of the high incidence of morbidity and mortality associated with invasive fungal infections, antifungal prophylaxis is often used in solid organ transplant recipients.Nebulized liposomal amphotericin B was used in addition to systemic therapy in order to optimize antifungal drug exposure; this regimen appeared to reduce the patient's fungal burden.Despite this apparent improvement, the patient's pulmonary status progressively declined in the setting of multiple comorbidities, ultimately leading to respiratory failure and death.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmacy, University of Colorado Hospital, Aurora, CO 80010, USA.

ABSTRACT
Because of the high incidence of morbidity and mortality associated with invasive fungal infections, antifungal prophylaxis is often used in solid organ transplant recipients. However, this prophylaxis is not universally effective and may contribute to the selection of emerging, resistant pathogens. Here we present a rare case of invasive infection caused by Microascus trigonosporus species complex in a human, which developed during voriconazole prophylaxis in a lung transplant recipient. Nebulized liposomal amphotericin B was used in addition to systemic therapy in order to optimize antifungal drug exposure; this regimen appeared to reduce the patient's fungal burden. Despite this apparent improvement, the patient's pulmonary status progressively declined in the setting of multiple comorbidities, ultimately leading to respiratory failure and death.

No MeSH data available.


Related in: MedlinePlus

Bronchoscopy images after two weeks of antifungal therapy with diffusely abnormal appearing mucosa and tan adherent plaques (arrows).
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fig5: Bronchoscopy images after two weeks of antifungal therapy with diffusely abnormal appearing mucosa and tan adherent plaques (arrows).

Mentions: Following two weeks of posaconazole therapy, repeat CXR denoted increased right-sided pleural effusion and new infiltrates in the right lower lobe (Figure 3). FEV1 was 1.08 L/s (33% predicted). A chest computed tomography scan was notable for a thick-walled cavitary lesion with mural nodularity involving the subpleural posterior right lower lobe and tree-in-bud centrilobular nodules within the right lower lobe (Figure 4). Repeat bronchoscopy demonstrated endobronchial, adherent tan-colored plaques throughout, tan secretions, and diffusely abnormal appearing mucosa (Figure 5). Pathology results from a transbronchial biopsy of the cavitary lesion demonstrated septated fungal hyphae, consistent with possible Aspergillus spp. Endobronchial biopsies of the plaques were notable for the finding of a small, detached fragment of matted fungal hyphae adjacent to but not penetrating the endobronchial mucosa (Figure 6). The BAL fluid became positive at day 4 after biopsy for moderate mold, again identified as Scopulariopsis sp. The patient was deemed not to be a surgical candidate for resection of the mycetoma based on his comorbidities. He was admitted for treatment of his invasive fungal infection with IV liposomal amphotericin B.


Invasive Microascus trigonosporus Species Complex Pulmonary Infection in a Lung Transplant Recipient.

Schoeppler KE, Zamora MR, Northcutt NM, Barber GR, O'Malley-Schroeder G, Lyu DM - Case Rep Transplant (2015)

Bronchoscopy images after two weeks of antifungal therapy with diffusely abnormal appearing mucosa and tan adherent plaques (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446491&req=5

fig5: Bronchoscopy images after two weeks of antifungal therapy with diffusely abnormal appearing mucosa and tan adherent plaques (arrows).
Mentions: Following two weeks of posaconazole therapy, repeat CXR denoted increased right-sided pleural effusion and new infiltrates in the right lower lobe (Figure 3). FEV1 was 1.08 L/s (33% predicted). A chest computed tomography scan was notable for a thick-walled cavitary lesion with mural nodularity involving the subpleural posterior right lower lobe and tree-in-bud centrilobular nodules within the right lower lobe (Figure 4). Repeat bronchoscopy demonstrated endobronchial, adherent tan-colored plaques throughout, tan secretions, and diffusely abnormal appearing mucosa (Figure 5). Pathology results from a transbronchial biopsy of the cavitary lesion demonstrated septated fungal hyphae, consistent with possible Aspergillus spp. Endobronchial biopsies of the plaques were notable for the finding of a small, detached fragment of matted fungal hyphae adjacent to but not penetrating the endobronchial mucosa (Figure 6). The BAL fluid became positive at day 4 after biopsy for moderate mold, again identified as Scopulariopsis sp. The patient was deemed not to be a surgical candidate for resection of the mycetoma based on his comorbidities. He was admitted for treatment of his invasive fungal infection with IV liposomal amphotericin B.

Bottom Line: Because of the high incidence of morbidity and mortality associated with invasive fungal infections, antifungal prophylaxis is often used in solid organ transplant recipients.Nebulized liposomal amphotericin B was used in addition to systemic therapy in order to optimize antifungal drug exposure; this regimen appeared to reduce the patient's fungal burden.Despite this apparent improvement, the patient's pulmonary status progressively declined in the setting of multiple comorbidities, ultimately leading to respiratory failure and death.

View Article: PubMed Central - PubMed

Affiliation: Department of Pharmacy, University of Colorado Hospital, Aurora, CO 80010, USA.

ABSTRACT
Because of the high incidence of morbidity and mortality associated with invasive fungal infections, antifungal prophylaxis is often used in solid organ transplant recipients. However, this prophylaxis is not universally effective and may contribute to the selection of emerging, resistant pathogens. Here we present a rare case of invasive infection caused by Microascus trigonosporus species complex in a human, which developed during voriconazole prophylaxis in a lung transplant recipient. Nebulized liposomal amphotericin B was used in addition to systemic therapy in order to optimize antifungal drug exposure; this regimen appeared to reduce the patient's fungal burden. Despite this apparent improvement, the patient's pulmonary status progressively declined in the setting of multiple comorbidities, ultimately leading to respiratory failure and death.

No MeSH data available.


Related in: MedlinePlus