Tsviban Lior, Kramer Mordechai R, Fridel Ludmila, Shostak Yael, Shitenberg Dorit, Rosengarten Dror, Heching Moshe, Pesachovich Yuri, Barac Yaron D, Shtraichman Osnat
Pulmonary Institute and Graub CF Center, Schneider Children's Medical Center, Petach Tikva, Israel.
Gray Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
J Thorac Dis. 2025 Aug 31;17(8):5883-5892. doi: 10.21037/jtd-2025-283. Epub 2025 Aug 15.
Pulmonary aspergilloma is a chronic fungal infection that can cause life-threatening massive hemoptysis or deteriorate into invasive fungal disease. Unilateral lung transplant recipients (LTRs) are at particular risk for developing this complication in their pathological native lung. This study aims to describe our experience with native lung aspergilloma, its management, and outcomes.
We collected a series of cases of native lung aspergilloma based on a retrospective chart review of all patients who underwent single lung transplantation (SLT) at Rabin Medical Center between November 1997 and March 2023.
In our cohort of 911 LTRs, 465 underwent SLT. The primary diagnoses were chronic obstructive pulmonary disease (COPD) in 166 patients (35%) and idiopathic interstitial pneumonia in 261 patients (56%). Five patients were identified with native lung aspergilloma, all with interstitial lung disease (ILD) as the primary diagnosis. The median time from transplantation to aspergilloma diagnosis was 45 months. Four patients received conservative treatment with antifungal therapy; three are alive with a median follow-up of 62 months, one of whom is being evaluated for surgical intervention. One patient died within 6 months, likely due to infection. Another patient underwent a successful pneumonectomy and survived for more than 8 years.
This case series emphasizes the importance of a high index of suspicion of aspergilloma developing in the native lung after an SLT. Although this is a significantly high-risk group due to their immunodeficiency, their overall prognosis in our study remains similar to that of non-immunocompromised patients.
肺曲菌球是一种慢性真菌感染，可导致危及生命的大量咯血或恶化为侵袭性真菌病。单侧肺移植受者（LTRs）在其病理性的原生肺中发生这种并发症的风险尤其高。本研究旨在描述我们在原生肺曲菌球方面的经验、其管理及结果。
我们通过对1997年11月至2023年3月期间在拉宾医疗中心接受单肺移植（SLT）的所有患者进行回顾性病历审查，收集了一系列原生肺曲菌球病例。
在我们的911名单侧肺移植受者队列中，465人接受了单肺移植。主要诊断为慢性阻塞性肺疾病（COPD）166例（35%），特发性间质性肺炎261例（56%）。5例被确诊为原生肺曲菌球，均以间质性肺疾病（ILD）作为主要诊断。从移植到曲菌球诊断的中位时间为45个月。4例患者接受了抗真菌治疗的保守治疗；3例存活，中位随访时间为62个月，其中1例正在评估手术干预。1例患者在6个月内死亡，可能死于感染。另1例患者接受了成功的肺切除术，存活超过8年。
本病例系列强调了对单肺移植后原生肺中发生曲菌球保持高度怀疑的重要性。尽管由于免疫缺陷，这是一个显著的高风险群体，但在我们的研究中他们的总体预后与非免疫受损患者相似。
