Terasaki J M, Shah S K, Schnadig V J, Valentine V G
Texas Transplant Center, University of Texas Medical Branch, Galveston, Texas, USA.
Transpl Infect Dis. 2014 Aug;16(4):621-4. doi: 10.1111/tid.12240. Epub 2014 Jun 3.
Fungal infections are common after lung transplantation. However, disseminated fusariosis is rare and we report the first case of airway complications associated with this infectious process. A 77-year-old Caucasian woman, who was status post left single-lung transplant for emphysema, presented to clinic 8 months after lung transplantation with pleurisy, shortness of breath, and declining lung function. Bronchoscopy showed narrowing of the left anastomotic site with dynamic compression during exhalation. An AERO stent was deployed successfully, but 3 weeks later, her symptoms recurred. Bronchoscopy showed total stent occlusion with thick tenacious mucus. Fusarium solani was isolated from cultures, and a new 1.5 cm skin nodule was found on the anteromedial midportion of the patient's left lower leg. Voriconazole and anidulafungin were started. No evidence of mucus accumulation was seen during a follow-up bronchoscopy. It is likely that Fusarium infection contributed to the initial anastomotic complication as well as to obstruction of the stent. Furthermore, the stent may have contributed to establishment and development of disseminated fusariosis. With antifungal therapy, stent patency was maintained and the patient improved clinically.
真菌感染在肺移植后很常见。然而，播散性镰刀菌病很少见，我们报告了首例与这种感染过程相关的气道并发症病例。一名77岁的白种女性，因肺气肿接受了左单肺移植，肺移植8个月后因胸膜炎、呼吸急促和肺功能下降到诊所就诊。支气管镜检查显示左吻合口处狭窄，呼气时出现动态压迫。成功植入了一个AERO支架，但3周后，她的症状复发。支气管镜检查显示支架完全被浓稠的黏液阻塞。从培养物中分离出茄病镰刀菌，并且在患者左小腿前内侧中部发现了一个1.5厘米的新皮肤结节。开始使用伏立康唑和阿尼芬净治疗。在后续的支气管镜检查中未发现黏液积聚的迹象。镰刀菌感染可能导致了最初的吻合口并发症以及支架阻塞。此外，支架可能促使播散性镰刀菌病的形成和发展。通过抗真菌治疗，支架保持通畅，患者临床症状改善。
