INVASIVE MOLD INFECTION AFTER LUNG TRANSPLANTATION PRESENTING AS A SINGLE PULMONARY NODULE

Abstract

TYPE: Case Report TOPIC: Transplantation INTRODUCTION: Lung transplant recipients commonly develop invasive fungal infections, particularly in the early postoperative course, despite appropriate antifungal prophylaxis. CASE PRESENTATION: The patient is a 68-year-old woman who received a bilateral lung transplant (09/2020) due to idiopathic pulmonary fibrosis. She received antifungal prophylaxis as deemed appropriate by our transplant center. She presented 10 months after transplant with acute cough. DISCUSSION: The patient had an uncomplicated early postoperative course without evidence of acute cellular rejection or infection leading up to her presentation. At 10 months, she was admitted for acute cough and radiographic imaging concerning for a new pulmonary nodule. Chest CT confirmed a 7 × 7 mm superior segment, left lower lobe, solid, non-calcified pulmonary nodule. Bronchoscopic tissue biopsy revealed Aspergillus spp, and the patient was switched from itraconazole to isavuconazole. In the same admission, mold was identified, which prompted repeat chest CT showing a small cluster of nodules around the initial left lower lobe nodule. Biopsy confirmed acute, granulomatous pneumonitis with fungal elements consistent with Zygomycetes spp. Intravenous amphotericin was initiated, and repeat chest CT four weeks later showed a reduction in the cluster of nodules. Notably, the Cylex ImmuKnow (IK) assay measurements remained low, with values below 100 ng/mL, confirming her high levels of immunosuppression. CONCLUSIONS: A single pulmonary nodule in an immunosuppressed patient requires prompt diagnostic efforts, as fungal airway colonization is common and can progress rapidly despite prophylaxis. IK assays may provide objective evidence of over-immunosuppression, placing patients at higher risk of infection. DISCLOSURE: Nothing to declare. KEYWORD: Lung transplantation