Management of postpneumonectomy Aspergillus empyema extending into the thoracic wall: a plea for radical surgery and caution when using liposomal amphotericin B.
Semi-invasive aspergillosis is a rare disease leading to severe complications even in fully immunocompetent patients. The therapeutic role of systemic and intrapleural antifungal agents remains not well known. We report herein the case of a 54-year-old woman who developed Aspergillus empyema invading the thoracic wall and subcutaneous tissues after completion pneumonectomy for aspergilloma. She initially was treated conservatively with systemic and intrapleural amphotericin B without any success and developed a severe anaphylactic reaction to intravenous liposomal amphotericin B (Ambisome). She then underwent an open-window thoracotomy with intrathoracic transposition of a latissimus dorsi muscle flap and was started on itraconazole therapy. The thoracostomy was closed after 6 months and the patient is doing well without any signs of recurrent infection after 3 years.
Centre Valaisan de Pneumologie, 3962 Montana, Switzerland.
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N
Lampo
A
A
Spiliopoulos
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M
Licker
J-M
JM
Tschopp