Acute death caused by invasive aspergillosis after living-donor liver transplantation despite good graft function: a case report.
Antifungal treatment
Invasive aspergillosis
Liver transplantation
Journal
Surgical case reports
ISSN: 2198-7793
Titre abrégé: Surg Case Rep
Pays: Germany
ID NLM: 101662125
Informations de publication
Date de publication:
12 May 2021
12 May 2021
Historique:
received:
31
03
2021
accepted:
07
05
2021
entrez:
12
5
2021
pubmed:
13
5
2021
medline:
13
5
2021
Statut:
epublish
Résumé
Invasive aspergillosis (IA) is one of the most serious causes of death after liver transplantation (LT). IA is the second most common fungal infection, and its mortality rate exceeds 80%. A 67-year-old man presented to our hospital because of fulminant hepatitis caused by hepatitis B virus. Candidiasis was detected in his sputum, and micafungin had already been administered. Living-donor LT was performed using a right lobe graft donated from his daughter with no intraoperative complications. Although he appeared to have good graft function, his oxygenation was inadequate, and a chest radiograph showed many invasive shadows on postoperative day 1. A computed tomography scan also showed many invasive shadows with the halo sign. A blood examination revealed positivity for Aspergillus antigen, and Aspergillus species were detected in his sputum. IA was diagnosed. The antifungal therapy was soon modified to amphotericin B combined with caspofungin. Despite good graft blood flow through the portal vein and hepatic artery and good graft function, the patient died of IA on postoperative day 3. The median time from LT to IA among reports published to date ranges from 18 to 25 days. The present report describes the first case of very early onset of IA after LT.
Sections du résumé
BACKGROUND
BACKGROUND
Invasive aspergillosis (IA) is one of the most serious causes of death after liver transplantation (LT). IA is the second most common fungal infection, and its mortality rate exceeds 80%.
CASE PRESENTATION
METHODS
A 67-year-old man presented to our hospital because of fulminant hepatitis caused by hepatitis B virus. Candidiasis was detected in his sputum, and micafungin had already been administered. Living-donor LT was performed using a right lobe graft donated from his daughter with no intraoperative complications. Although he appeared to have good graft function, his oxygenation was inadequate, and a chest radiograph showed many invasive shadows on postoperative day 1. A computed tomography scan also showed many invasive shadows with the halo sign. A blood examination revealed positivity for Aspergillus antigen, and Aspergillus species were detected in his sputum. IA was diagnosed. The antifungal therapy was soon modified to amphotericin B combined with caspofungin. Despite good graft blood flow through the portal vein and hepatic artery and good graft function, the patient died of IA on postoperative day 3. The median time from LT to IA among reports published to date ranges from 18 to 25 days.
CONCLUSIONS
CONCLUSIONS
The present report describes the first case of very early onset of IA after LT.
Identifiants
pubmed: 33978845
doi: 10.1186/s40792-021-01203-w
pii: 10.1186/s40792-021-01203-w
pmc: PMC8116460
doi:
Types de publication
Journal Article
Langues
eng
Pagination
118Références
Clin Infect Dis. 2003 Jan 1;36(1):46-52
pubmed: 12491201
Liver Transpl. 2016 Feb;22(2):163-70
pubmed: 26515643
Transpl Infect Dis. 2019 Feb;21(1):e13007
pubmed: 30295407
Clin Infect Dis. 2016 Aug 15;63(4):e1-e60
pubmed: 27365388
Int J Infect Dis. 2011 May;15(5):e298-304
pubmed: 21345708
Med Mycol. 2013 Feb;51(2):155-63
pubmed: 22800082
Clin Infect Dis. 2020 Sep 12;71(6):1367-1376
pubmed: 31802125
Liver Transpl. 2002 Nov;8(11):1065-70
pubmed: 12424722
Sci Rep. 2019 Aug 15;9(1):11919
pubmed: 31417154
Curr Opin Pharmacol. 2015 Oct;24:38-44
pubmed: 26218924
Surg Today. 2021 Mar 18;:
pubmed: 33738584
Liver Transpl. 2015 Feb;21(2):204-12
pubmed: 25348192
Cochrane Database Syst Rev. 2015 Dec 30;(12):CD007394
pubmed: 26716951
N Engl J Med. 2002 Aug 8;347(6):408-15
pubmed: 12167683
Clin Transplant. 2019 Sep;33(9):e13544
pubmed: 30900296
Transpl Infect Dis. 2016 Aug;18(4):538-44
pubmed: 27237076
Am J Transplant. 2008 Feb;8(2):426-31
pubmed: 18190655
Liver Transpl. 2007 Apr;13(4):566-70
pubmed: 17394155
Transpl Infect Dis. 2018 Aug;20(4):e12898
pubmed: 29668068
Lancet. 2016 Feb 20;387(10020):760-9
pubmed: 26684607
BMC Infect Dis. 2021 Mar 24;21(1):296
pubmed: 33761875
Clin Infect Dis. 2007 Feb 1;44(3):373-9
pubmed: 17205443
Br J Radiol. 2012 Aug;85(1016):e429-35
pubmed: 22496071