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

Area of Science:

• Mycology
• Transplant Infectious Diseases
• Pharmacology

Background:

• Invasive fungal infections (IFIs) pose significant risks for solid organ transplant (SOT) recipients, contributing to high morbidity and mortality.
• Standard antifungal prophylaxis in SOT recipients is not always effective and can drive the emergence of drug-resistant fungal strains.
• Voriconazole is a commonly used antifungal agent for prophylaxis in this patient population.

Purpose of the Study:

• To report a rare case of invasive infection caused by the Microascus trigonosporus species complex in a human.
• To describe the clinical course and management of a lung transplant recipient who developed this infection during voriconazole prophylaxis.
• To evaluate the use of nebulized liposomal amphotericin B as an adjunct therapy to optimize antifungal drug exposure.

Main Methods:

• Case report of a lung transplant recipient.
• The patient received voriconazole prophylaxis.
• Treatment included systemic antifungal therapy and adjunctive nebulized liposomal amphotericin B.

Main Results:

• The patient developed an invasive infection due to the Microascus trigonosporus species complex while on voriconazole prophylaxis.
• The addition of nebulized liposomal amphotericin B appeared to reduce the patient's fungal burden.
• Despite treatment, the patient experienced progressive pulmonary decline due to comorbidities, leading to respiratory failure and death.

Conclusions:

• This case highlights the emergence of rare fungal pathogens like Microascus trigonosporus in immunocompromised patients.
• Voriconazole prophylaxis may not prevent all IFIs and can be associated with breakthrough infections.
• Aggressive combination therapy, including novel delivery methods like nebulized liposomal amphotericin B, may help manage fungal burden but does not guarantee survival in complex cases.