Letter to the Editor: Cavitary Pulmonary Aspergillosis in Heart Transplantation Recipient

Abstract

A 53-year-old male, a heart transplantation recipient for dilated cardiomyopathy under immunosuppressants and with a history of diabetes mellitus, presented with a productive cough and chest pain for days. Additionally, he had a low-grade fever and progressive dyspnea. Chest imaging revealed multiple cavitary lesions, the largest being 8.8 x 6.4 cm over the left upper lobe (Figure 1A, arrows), indicative of fungal infections. Microbiological analysis detected Aspergillus fumigatus in sputum, alongside elevated galactomannan optical density index levels in bronchoalveolar fluid (18) and serum (3.7). Voriconazole was administered, and surgical resection of the large cavity (Figure 1B) was performed, confirming cavitary pulmonary aspergillosis upon histopathological examination. Despite antifungal therapy, the patient's condition deteriorated, resulting in death two weeks later. This case highlights the challenging management of cavitary pulmonary aspergillosis in immunocompromised patients, particularly in the context of heart transplantation and diabetes mellitus. Despite aggressive antifungal therapy and surgical intervention, the poor prognosis underscores the need for early detection and targeted treatment strategies in complex clinical scenarios.