title: Adjuvant intrapleural amphotericin B therapy for pulmonary mucormycosis in a cardiac allograft recipient.
abstract: Infectious complications after heart transplantation remain a major cause of morbidity and mortality. While many viral, bacterial, and protozoal infections can be successfully treated, fungal infections continue to be challenging. Mucormycosis is a rare infection in heart transplant recipients; however, mortality is exceedingly high. We report a case of cavitary Rhizopus lung infection 2 months after cardiac transplantation. The infection was complicated by inadvertent exposure of the pleural cavity to the fungus during surgical resection. Therapy consisted of standard systemic amphotericin B, surgical excision, and for the first time, the use of adjuvant intrapleural amphotericin B. Cure was achieved with no clinical or radiological evidence of disease at 3 months follow-up. Rhizopus pulmonary infection is a rare complication of cardiac transplantation. Treatment consists of the triad of systemic anti-fungal therapy, surgical resection, and control of any underlying predisposing diseases. Adjuvant intrapleural amphotericin B use could also be considered in patients with fungal pneumonias and evidence of chest wall and/or pleural cavity involvement.
authors.affiliation: Department of Medicine, Salt Lake City Veterans Affairs Medical Center, Utah, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: J C
authors.initials: JC
authors.lastname: Smith
authors.forename: H H
authors.initials: HH
authors.lastname: Farhoud
authors.forename: D A
authors.initials: DA
authors.lastname: Terreros
authors.forename: J C
authors.initials: JC
authors.lastname: Stringham
authors.forename: D O
authors.initials: DO
authors.lastname: Taylor
authors.forename: D G
authors.initials: DG
authors.lastname: Renlund
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D015552:Injections, Intralesional; D008172:Lung Diseases, Fungal / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011013:Pneumonectomy; D011183:Postoperative Complications; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B