Muhm M, Zuckermann A, Prokesch R, Pammer J, Hiesmayr M, Haider W
Department of Cardiothoracic and Vascular Anesthesia, University of Vienna Medical School, Austria.
Transplantation. 1996 Oct 27;62(8):1185-7. doi: 10.1097/00007890-199610270-00029.
Pulmonary infections are major complications in heart transplantation. Progress in antimicrobial chemotherapy has switched the clinical spectrum to an increased incidence of fungal pathogens, such as Candida and Aspergillus species. Mucormycosis is a rare opportunistic infection with high mortality in solid-organ transplant recipients usually ensuing several months after transplantation. We describe a 45-year-old patient with pulmonary mucormycosis manifestion 5 days after heart transplantation. The infection resulted in pulmonary vein thrombosis followed by hemorrhagic infarction. Despite antifungal treatment and surgical resection, the patient died on day 14 after transplantation. Antemortem diagnostic procedures were negative; autopsy confirmed the presence of Rhizopus oryzae invading blood vessels. We conclude that physicians must be aware of mucormycosis even within one week after heart transplantation--which has not been described so far. Invasive diagnostic workup is mandatory in case of suspicion; amphotericin B and, in selected cases, surgical resection are the mainstays of therapy.
肺部感染是心脏移植的主要并发症。抗菌化疗的进展已使临床谱转向真菌病原体（如念珠菌和曲霉菌）发病率增加。毛霉菌病是一种罕见的机会性感染，在实体器官移植受者中死亡率很高，通常在移植后数月发生。我们描述了一名45岁的患者，在心脏移植后5天出现肺部毛霉菌病表现。感染导致肺静脉血栓形成，随后发生出血性梗死。尽管进行了抗真菌治疗和手术切除，但患者在移植后第14天死亡。生前诊断程序均为阴性；尸检证实存在米根霉侵犯血管。我们得出结论，医生必须意识到即使在心脏移植后一周内也可能发生毛霉菌病——这在之前尚未有过描述。如有怀疑，必须进行侵入性诊断检查；两性霉素B以及在特定情况下的手术切除是主要治疗方法。
