Invasive Aspergillosis in a Renal Transplant Recipient Successfully Treated with Interferon-Gamma

C. Estrada,F. Darras,A. G. Desai,E. P. Nord,R. Seidman,H. Suh,L. M. Chirch

doi:10.1155/2012/493758

Abstract

Invasive aspergillosis is a serious complication of solid organ transplantation. An early diagnosis is hampered by the lack of reliable serum markers and, even if appropriately diagnosed and treated with current antifungal agents, has a high mortality rate. We report a case of invasive pulmonary and cerebral aspergillosis in a renal transplant patient treated with IFN-γ in conjunction with combination anti-fungal therapy for six weeks in whom complete resolution of the fungal infection was achieved. Renal function remained intact throughout the treatment period. Surveillance CT scans of the chest and head showed resolution of prior disease but revealed a new left upper lobe mass four months after completion of treatment with IFN-γ. Biopsy of the lesion was positive for primary lung adenocarcinoma, for which she underwent left upper lobe resection. The pathology report confirmed clear surgical margins and lymph nodes and no evidence of fungal hyphae. IFN-γ should be considered early in the management of invasive aspergillosis in renal transplant patients. To date, allograft rejection has not been encountered.

Highlights

Invasive aspergillosis (IA) is a serious complication of solid organ transplantation
The use of interferon-gamma (IFN-γ) to treat invasive fungal infections is derived from animal models that showed resistance to disease correlated with an intact Th1 response [6] and protection was associated with high levels of tumor necrosis factor alpha (TNF-α), interleukin-2 (IL-2), interleukin-12 (IL-12), and IFN-γ [7]
We report a case of invasive pulmonary and cerebral aspergillosis, coinfected with cytomegalovirus (CMV) pneumonitis, in a renal transplant recipient, successfully treated with adjunctive IFN-γ, after combination antifungal therapy failed to eradicate the infection

Summary

Introduction

Invasive aspergillosis (IA) is a serious complication of solid organ transplantation. The use of interferon-gamma (IFN-γ) to treat invasive fungal infections is derived from animal models that showed resistance to disease correlated with an intact Th1 response [6] and protection was associated with high levels of tumor necrosis factor alpha (TNF-α), interleukin-2 (IL-2), interleukin-12 (IL-12), and IFN-γ [7]. Current immunosuppressive therapy blunts cell-mediated immunity, thereby predisposing organ transplant recipients to invasive fungal infections. IFN-γ has the potential to augment this defect in immunity, eradicate invasive fungal disease, and far has not been associated with allograft rejection [8]. We report a case of invasive pulmonary and cerebral aspergillosis, coinfected with cytomegalovirus (CMV) pneumonitis, in a renal transplant recipient, successfully treated with adjunctive IFN-γ, after combination antifungal therapy failed to eradicate the infection

Case Report

Findings

Discussion