J Korean Soc Transplant.  2012 Sep;26(3):202-206. 10.4285/jkstn.2012.26.3.202.

Simultaneous Lung and Liver Aspergillus in a Kidney Transplant Recipient

• Park J
• Hwang E
• Park S
• Kim H
• Kim H

• KMID: 2003536
• DOI: http://doi.org/10.4285/jkstn.2012.26.3.202

Abstract

Invasive opportunistic infection by Aspergillus fungus is life-threatening for kidney transplant recipients. The occurrence of aspergillosis by hematogenous dissemination can affect multiple organs. Despite having a lower incidence rate relative to bacterial or viral infections in kidney transplant recipients, fungal infections produce the highest number of mortalities. We report a simultaneous case of invasive aspergillosis in the lung and liver of a 52-year-old female patient who underwent living donor kidney transplant. She suffered massive blood loss and high-volume transfusions due to postoperative bleeding. One month after transplantation, she reported intermittent coughing without febrile sensation. Computed tomography revealed nodules on the right and left upper lobes of the lung and multiple cystic liver lesions. Based on pathologic findings and culture from aspirate, she was diagnosed with invasive aspergillosis involving the liver and lung. After a 4 month voriconazole treatment the nodules in the lung and liver disappeared.

Keyword

Kidney transplantation; Fungal; Aspergillus

MeSH Terms

Aspergillosis
Aspergillus
Cough
Female
Fungi
Hemorrhage
Humans
Incidence
Kidney
Kidney Transplantation
Liver
Living Donors
Lung
Middle Aged
Opportunistic Infections
Pyrimidines
Sensation
Transplants
Triazoles
Pyrimidines
Triazoles

Figure

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  Fig. 1 Nodular opacities were newly developed in left and right upper lung.

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  Fig. 2 (A) Chest computed tomography (CT) revealed contrast enhanced nodular consolidations in right upper lobe apical and left upper lobe apicoposterior segment. (B) Abdominal CT revealed multiple cystic lesions with enhancing wall in right and left hepatic lobes.

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  Fig. 3 (A) Lung biopsy. Many fungal organisms were identified in inflammatory and necrotic areas (Gomori-methenamine silver stain, ×400). (B) Liver aspiration. Delicate blue hyphae and fruiting structures were identified in cystic lesions (Lactophenol cotton blue stain, ×400).

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  Fig. 4 Subpleural lung nodules (A) and multiple hepatic abscesses (B) were not detected after treatment with voriconazole for 4 months.

Reference

1. Singh N, Paterson DL. Aspergillus infections in transplant recipients. Clin Microbiol Rev. 2005. 18:44–69.

2. Minari A, Husni R, Avery RK, Longworth DL, DeCamp M, Bertin M, et al. The incidence of invasive aspergillosis among solid organ transplant recipients and implications for prophylaxis in lung transplants. Transpl Infect Dis. 2002. 4:195–200.

3. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008. 46:327–360.

4. Paya CV. Fungal infections in solid-organ transplantation. Clin Infect Dis. 1993. 16:677–688.

5. Gavalda J, Len O, San Juan R, Aguado JM, Fortun J, Lumbreras C, et al. Risk factors for invasive aspergillosis in solid-organ transplant recipients: a case-control study. Clin Infect Dis. 2005. 41:52–59.

6. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002. 347:408–415.

7. Marty FM, Cosimi LA, Baden LR. Breakthrough zygomycosis after voriconazole treatment in recipients of hematopoietic stem-cell transplants. N Engl J Med. 2004. 350:950–952.

8. Venkataramanan R, Zang S, Gayowski T, Singh N. Voriconazole inhibition of the metabolism of tacrolimus in a liver transplant recipient and in human liver microsomes. Antimicrob Agents Chemother. 2002. 46:3091–3093.

9. Greene RE, Schlamm HT, Oestmann JW, Stark P, Durand C, Lortholary O, et al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 2007. 44:373–379.