Caron Julien, Conti Massimo, Pietro Rinaldi, Tessier Michel, Gervais Phillipe, Dubois-Sénéchal Sacha-Michelle, Cinq-Mars Alexandre, Dubois Michelle, Sénéchal Mario
From the Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.
Exp Clin Transplant. 2019 Oct;17(5):695-698. doi: 10.6002/ect.2018.0185. Epub 2019 Apr 9.
Aspergillus fumigatus is an opportunistic fungus that mainly affects immunocompromised patients. Due to significant immunosuppressive therapy, patients who undergo orthotopic heart transplant have an increased risk of infection. Aspergillosis is the most common fungal infection in orthotopic heart transplant recipients (70%) and usually presents as invasive aspergillosis, which has a rapidly progressive course and is highly fatal. In heart transplant patients with invasive aspergillosis, overall mortality may range from 53% to 78%. Aspergillus mediastinitis infection is somewhat rare in orthotopic heart transplant recipients, with only 6 reported cases. Treatment may require early surgical drainage and antifungal therapy. We present the case of a 50-year-old man who developed Aspergillus mediastinitis 1 year after heart transplant surgery. This case illustrates the diagnostic challenge of an atypical presentation of Aspergillus mediastinitis and the importance of multiple drainage procedures in refractory disease, combined with long-term antifungal therapy.
烟曲霉是一种机会性真菌，主要影响免疫功能低下的患者。由于进行了显著的免疫抑制治疗，接受原位心脏移植的患者感染风险增加。曲霉病是原位心脏移植受者中最常见的真菌感染（70%），通常表现为侵袭性曲霉病，其病程进展迅速且死亡率很高。在患有侵袭性曲霉病的心脏移植患者中，总体死亡率可能在53%至78%之间。曲霉性纵隔炎感染在原位心脏移植受者中较为罕见，仅有6例报告病例。治疗可能需要早期手术引流和抗真菌治疗。我们报告了一例50岁男性患者，在心脏移植手术后1年发生了曲霉性纵隔炎。该病例说明了曲霉性纵隔炎非典型表现的诊断挑战以及在难治性疾病中多次引流程序与长期抗真菌治疗相结合的重要性。
