Macroscopic Aspergillus Infection at the Anastomosis of a Lung Transplant Recipient

Abstract

A 65-year-old female with a history of right lung transplantation (LTx) for chronic obstructive pulmonary disease (COPD) 9-years prior complicated by grade 3 bronchiolitis obliterans syndrome (BOS) was admitted to the hospital for chest pain and dyspnea on exertion (DOE). Her bronchoscopy revealed fluffy, endobronchial lesions that were adherent to the right sided anastomosis resulting in mild obstruction of the right mainstem bronchus. Pathology from biopsies of the endobronchial lesions revealed hyphal fungal organisms consistent with Aspergillus species. Following antifungal therapy with voriconazole, her follow up bronchoscopy 37 days post the original bronchoscopy revealed resolution of the endobronchial lesions. The patient’s case is unique in: presentation 9 years post-transplantation, the absence of prior Aspergillus colonization, and the appearance of the endobronchial lesions. Following Ltx, immunosuppression in combination with allograft exposure to the environment increases the risk of opportunistic infections, especially saprophytic infections including Aspergillus.