Black mold takes hold and story told

Area of Science:

• Medical Mycology
• Transplant Infectious Diseases
• Pulmonology

Background:

• Lung transplantation is a life-saving procedure for end-stage lung disease.
• Invasive fungal infections pose a significant threat to transplant recipients.
• Prophylactic antifungal therapy is standard to prevent post-transplant infections.

Observation:

• A case of invasive Curvularia infection is presented in a bilateral orthotopic lung transplant recipient.
• The patient received standard post-transplant antifungal prophylaxis.
• The infection manifested as extensive mold colonies within chest tubes.

Findings:

• Despite aggressive treatment including surgical washout and broad-spectrum antifungals (liposomal amphotericin B, micafungin, isavuconazonium sulfate), the infection was refractory.
• The patient succumbed to the invasive Curvularia infection.

Implications:

• This case underscores the potential for breakthrough fungal infections in immunocompromised transplant patients.
• Challenges in managing invasive mold infections post-lung transplantation require further investigation.
• The limitations of current antifungal prophylaxis and treatment strategies in preventing fatal outcomes are highlighted.