Invasive aspergillosis (IA) is a common fungal infection in immunocompromised patients with a high mortality rate. We report the case of a 49-year old man with history of fever and chills 4 months after kidney transplantation. Physical examination and chest radiography were normal. Laboratory tests showed CRP elevation (78 mg/l). Blood cultures and urine bacteriology were sterile. Cytomegalovirus-antigenemia negative. Computed tomography (CT) of the chest discluded a small nodular lesion (1,2 cm) in the left lower lobe. No pathogenic organism was identified by bronchoalveolar lavage. Serology for toxoplasmosis and cryptococcal antigen were negative. Control CT of the chest 2 weeks later revealed minimal progression of the pulmonary lesion and an in-homogenous enlargement of the thyroid gland. Fine needle aspiration of the thyroid revealed growth of Aspergillus jumigatus. Inspite of anti-fungal therapy with liposomal Amphotericin B the patient remained febrile. Echocardiography and MRI of the heart showed fibrotic pericarditis and several myocardial abscesses, suggesting disseminated IA. Caspofungin and flucytosine was added to amphotericin B. Flucytosine was stopped after 2 weeks because of leukopenia. Three months after the therapy of amphotericin B and caspofungin, we observed favourable clinical course, regression of the pulmonary lesions and vanishing of the myocardial abscesses. The patient was discharged on oral itraconazole. In conclusion, we report an unusual clinical presentation of invasive aspergillosis with multiple myocardial abscesses in an immunocompromised patient with favourable outcome under experimental antifungal combination therapy.
Full conference title:
12th International Symposium on Infections in the Immunocompromised Host
- ISIIH 12th