Abstract
Invasive fungal infections are very common in solid organ transplants and occur most frequently in the first three months after transplant. A 49-year-old female with a history of two remote heart transplants with the most recent one occurring 5 years ago was admitted for increasing shortness of breath, cough, and fever. Computerized tomography (CT) scan of the chest showed left lower lung ground-glass and tree-in-bud opacities. She was started on broad spectrum antibiotics along with ganciclovir and micafungin. Ganciclovir was added due to the patient's past history of CMV infection and empiric fungal coverage with micafungin. Bronchoalveolar lavage (BAL) was performed as her respiratory status worsened and voriconazole was added for possible aspergillosis in combination therapy with micafungin. BAL galactomannan returned positive which was suggestive of aspergillosis. Patient worsened clinically and subsequently succumbed to cardiorespiratory arrest despite our best efforts. It is important to have a high degree of clinical suspicion for invasive aspergillosis in transplant patients even many years after transplant and initiate aggressive therapy due to poor outcomes.
Highlights
Heart transplant recipients are at risk of invasive fungal infections, a fatal complication of any transplant [1]
We hereby present a patient with a history of remote heart transplant and a retransplant 5 years ago due to CMV induced rejection that presented with invasive aspergillosis leading to death in spite of being on multiple antifungal therapy
The patient experienced acute rejection grade IIR diagnosed by endocardial biopsy, Case Reports in Infectious Diseases which had improved with pulse-dose steroids for three days
Summary
Heart transplant recipients are at risk of invasive fungal infections, a fatal complication of any transplant [1]. Neutropenia, graft versus host disease, corticosteroid therapy, and cytomegalovirus infection increase the risk of having invasive aspergillosis [2, 3]. With new changes in the immunosuppressive and antimicrobial prophylactic regimen over the past 30 years, the incidence of invasive aspergillosis has significantly decreased [4]. We hereby present a patient with a history of remote heart transplant and a retransplant 5 years ago due to CMV induced rejection that presented with invasive aspergillosis leading to death in spite of being on multiple antifungal therapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
