[A case of receipieut of kidney transplantation presenting life-threatning preumothorax due to the rupture of intrapulmonary multiple infections cavities caused by Absidia corymbifera and methicillin-resistant Staphylococcus aureus].
We report a rare case of life-threatning pneumothorax induced by multiple intrapulmonary cavitary lesion due to Absidia corymbifera and methicillin-resistant Staphylococcus aureus (MRSA). The patient was a 58-year-old man who had undergone kidney transplantation three year ago due to diabetes renal failure. He had been treated with immunosuppressive drugs and prednisolone, but he had neutropenia and an abnormal shadow on the chest X-ray. His chest X-ray findings became worse inspite of broad-spectrum antibiotis, vancomycin, antivirus drug, gamma-globulin and antifungal drug therapy. He came to our emergency center because of dyspnea due to right massive pleural effusion and peumothorax about two months after onset of neutropenia. His arterial blood gas showed severe hypoxia and the chest CT scan showed birateral pleural effusion and multiple intrapulmonary cavities. He was treated with chest tube drainage and intubated, but he died of progressive respiratory failure on admission day 3. Macroscopic and microbiologic findings of necroptic lung revealed the cavity with fistula in the middle lobe, which included debris with mucor and MRSA. The species of mucor identified as Absidia corymbifera as a result of analysis of BLAST with nested-PCR using the palafin-block.
Morimatsu
Yoshitaka
Y
First Department of Internal Medicine, Kurume University School of Medicine.
Sano
Ayako
A
Yukutake
Nao
N
Imaoka
Haruki
H
Nishimura
Kazuko
K
Aizawa
Hisamichi
H
D020095:Absidia; D017809:Fatal Outcome; D006801:Humans; D016030:Kidney Transplantation; D008171:Lung Diseases / Q000150:complications*; D008172:Lung Diseases, Fungal / Q000150:complications*; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications*; D011030:Pneumothorax / Q000382:microbiology*; D011183:Postoperative Complications; D012422:Rupture, Spontaneous; D013203:Staphylococcal Infections / Q000150:complications*