Refractory pulmonary aspergillosis treated with caspofungin after heart-lung transplantation

Invasive pulmonary aspergillosis (IPA) is a serious complication of lung transplantation. Pre-mortem diagnosis is difficult and is made according to defined criteria. Most patients with a post mortem diagnosis of IPA only reach the possible or probable levels of diagnostic certainty during life. Her...

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Bibliographic Details
Published in:Transplant international 2004-10, Vol.17 (9), p.545-548
Main Authors: CARBY, Martin R, HODSON, Margaret E, BANNER, Nicholas R
Format: Article
Language:English
Subjects:
Adult
Antifungal Agents - therapeutic use
Aspergillosis, Allergic Bronchopulmonary - diagnostic imaging
Aspergillosis, Allergic Bronchopulmonary - drug therapy
Aspergillosis, Allergic Bronchopulmonary - etiology
Biological and medical sciences
Echinocandins
Heart-Lung Transplantation - adverse effects
Human mycoses
Humans
Infectious diseases
Lipopeptides
Male
Medical sciences
Mycoses
Mycoses of the respiratory system
Nephrology. Urinary tract diseases
Peptides, Cyclic - therapeutic use
Pharmacology. Drug treatments
Pseudomonas aeruginosa
Pseudomonas Infections - drug therapy
Pseudomonas Infections - etiology
Radiography, Thoracic
Tomography, Spiral Computed
Treatment Outcome
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Summary:Invasive pulmonary aspergillosis (IPA) is a serious complication of lung transplantation. Pre-mortem diagnosis is difficult and is made according to defined criteria. Most patients with a post mortem diagnosis of IPA only reach the possible or probable levels of diagnostic certainty during life. Here, we report a case of probable IPA that was refractory to conventional treatment, including amphotericin, but which responded to therapy with caspofungin. A 23-year-old man underwent heart-lung transplantation for cystic fibrosis. Ten years after transplantation he developed IPA. His condition continued to deteriorate despite treatment with itraconazole, liposomal amphotericin and flucytosine together with treatment of a concomitant infection with Pseudomonas aeruginosa. Following treatment with caspofungin there was progressive and sustained clinical and radiological improvement. No adverse reaction occurred during treatment. Caspofungin should be considered as an alternative treatment for IPA in lung transplant recipients who fail to respond to other therapy.
ISSN:0934-0874
1432-2277
DOI:10.1007/s00147-004-0753-0