Refractory pulmonary aspergillosis treated with caspofungin after heart-lung transplantation

• 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
• ISSN: 0934-0874; 1432-2277
• DOI: 10.1007/s00147-004-0753-0

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.