title: Aspergillosis with Aspergillus osteomyelitis and diskitis after heart transplantation: surgical and medical management.
abstract: This is the report of a 49-year-old man, who could be cured of aspergillosis with Aspergillus osteomyelitis and diskitis of the lumbar spine by medical and surgical therapy after heart retransplantation. Aspergillus osteomyelitis and diskitis is a rare complication of invasive aspergillosis. Lumbar involvement is the main manifestation, followed by rare locations in the tibia, ribs, wrist, sternum, pelvis, and knee. It is nearly always secondary to pulmonary aspergillosis, which occurs in about 6% to 14% of patients after heart transplantation. For treatment, a combined surgical and medical approach is recommended, which enables quick pain relief for the patient and histologic and microbiologic diagnosis and stabilization of the spine. Because of definitive cure of osteomyelitis cannot be guaranteed by removal of the abscess, medical therapy after surgery is necessary for years.
authors.affiliation: German Heart Institute Berlin, Division of Thoracic and Cardiovascular Surgery.
authors.forename: M
authors.initials: M
authors.lastname: Hummel
authors.forename: S
authors.initials: S
authors.lastname: Schüler
authors.forename: U
authors.initials: U
authors.lastname: Weber
authors.forename: G
authors.initials: G
authors.lastname: Schwertlick
authors.forename: S
authors.initials: S
authors.lastname: Hempel
authors.forename: D
authors.initials: D
authors.lastname: Theiss
authors.forename: W
authors.initials: W
authors.lastname: Rees
authors.forename: J
authors.initials: J
authors.lastname: Mueller
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D001228:Aspergillosis / Q000209:etiology* / Q000628:therapy; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D003131:Combined Modality Therapy; D015299:Discitis / Q000382:microbiology* / Q000628:therapy; D005437:Flucytosine / Q000627:therapeutic use; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007403:Intervertebral Disc / Q000601:surgery; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology* / Q000628:therapy; D013122:Spinal Diseases / Q000382:microbiology / Q000628:therapy
chemical_list: D000666:Amphotericin B; D005437:Flucytosine