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Published on: March 22, 2012
Invasive cardiac aspergillosis after orthotopic liver transplantation
G Wiltberger1, M Schmelzle1, S Schubert2
1Department of Visceral, Transplantation, Thorax and Vascular Surgery, University of Leipzig, Leipzig, Germany.
Abstract:
Invasive aspergillus infection occurs in 5 - 42 % of liver-transplanted recipients and is a dangerous complication, associated with high mortality if untreated. However, the early diagnosis of invasive aspergillosis can be elusive, as clinical signs are unspecific and the pathogenic agent is difficult to demonstrate. We here report about a 58-year-old man with acute liver failure caused by newly diagnosed chronic hepatitis B infection who underwent liver transplantation. The postoperative course was uneventful, and the patient was discharged after 30 days. After 105 days the patient was readmitted because of fever, recurrent chest and abdominal pain. Computed tomography revealed a cardiac lesion; other diagnostic steps including bone-marrow and endomycordial biopsy, virological and microbiological investigations gave no clear findings. To exclude a malignant process, thoracotomy with mass and simultaneous lower left lobe resection were performed. Histopathological findings revealed an invasive perimyocardial aspergillosis. Immediate intravenous therapy with voriconazole and caspofungin was initiated and monitoring of the mass was performed with transesophageal echocardiography and Cardio-MRI. Due to slightly increase of the lesion, medication was switched to posaconazole and caspofungin. Under this dual fungal treatment the lesion regressed and the patient could be discharged after two months in good clinical condition. Frequent Cardio-MRI scan after discharge showed further mass-regression. Therefore antifungal treatment was switched to oral posaconazole mono-therapy. After one year, complete reduction of the mass was achieved and antifungal therapy was discontinued. Recent diagnostic imaging follow-up showed no pathological finding.
Insights
Invasive aspergillosis is a dangerous complication after liver transplantation. This case report details successful treatment of invasive perimyocardial aspergillosis with combination antifungal therapy and monitoring.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Cardiology
Background:
- Invasive aspergillosis is a severe complication in liver transplant recipients, often presenting with non-specific symptoms and posing diagnostic challenges.
- Early and accurate diagnosis is crucial for effective management and improving patient outcomes.
Observation:
- A 58-year-old male liver transplant recipient developed fever and chest/abdominal pain 105 days post-transplant.
- Cardiac lesion identified via CT; further diagnostics, including biopsies, were inconclusive.
- Thoracotomy revealed invasive perimyocardial aspergillosis.
Findings:
- Initial treatment with voriconazole and caspofungin, followed by a switch to posaconazole and caspofungin due to lesion increase.
- Dual antifungal therapy led to lesion regression, enabling discharge.
- Complete mass regression achieved after one year of oral posaconazole monotherapy.
Implications:
- This case highlights the importance of considering invasive aspergillosis in liver transplant patients with unexplained symptoms and cardiac lesions.
- Successful management involved a combination of aggressive antifungal therapy, surgical intervention, and close monitoring with advanced imaging.
- The successful outcome underscores the efficacy of sequential and combination antifungal strategies in treating invasive cardiac aspergillosis.
