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Caspofungin-resistant Aspergillus flavus after heart transplantation and mechanical circulatory support: a case

S Eschertzhuber1, C Velik-Salchner, C Hoermann

  • 1Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria. stephan.eschertzhuber@uibk.ac.at

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|July 4, 2007
PubMed

Insights

Invasive aspergillosis (IA) is a severe post-transplant complication. A cardiac transplant patient with IA developed right heart failure and died due to multi-organ failure, with resistant Aspergillus strains.

Area of Science:

  • Medicine
  • Infectious Diseases
  • Cardiology

Background:

  • Invasive aspergillosis (IA) poses a significant threat to solid organ transplant recipients.
  • Early diagnosis and targeted antifungal therapy are crucial for managing IA in this vulnerable population.

Observation:

  • A 49-year-old patient developed IA following a cardiac transplant.
  • The patient experienced severe post-transplant right heart failure, necessitating mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and a right ventricular assist device.

Findings:

  • Despite comprehensive antifungal treatment, the patient succumbed to multi-organ failure attributed to IA.
  • In vitro analysis revealed that the isolated Aspergillus strains demonstrated resistance to caspofungin, a key antifungal agent.

Implications:

  • This case highlights the critical challenges in managing IA post-cardiac transplantation, especially when complicated by cardiac dysfunction.
  • The observed in vitro resistance to caspofungin underscores the need for vigilant monitoring of antifungal susceptibility and exploration of alternative therapeutic strategies in IA cases.

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