title: [Cardiac invasive aspergillosis in a heart transplant recipient].
abstract: BACKGROUND
  Solid organ transplant recipients are a population at risk of invasive aspergillosis. The lung and the central nervous system are usually affected.
  
  
  OBJECTIVE
  We report the case of a patient with proven cardiac invasive aspergillosis two years after heart transplantation, and perform a review of cardiac aspergillosis in solid organ transplant recipients.
  
  
  METHODS
  A 52-year old woman received a heart transplant. Several complications appeared in the post-operative period, including the development of invasive aspergillosis in the surgical wound. She was readmitted two years later with dyspnea. A thoracic CT-scan revealed multiple lung embolisms and a mass in the retroxiphoid, invading the right atrium and the tricuspid valve. Septated hyphae invading this tissue were observed and Aspergillus fumigatus was subsequently isolated. Serum galactomannan determinations were negative. Antifungal therapy with voriconazole was started. Two months later, the patient visited the hospital for a routine check-up control in good clinical condition, but with undetectable voriconazole serum levels. These levels were associated to the concomitant use of omeprazole. One year later, the patient was still receiving voriconazole and remained asymptomatic.
  
  
  CONCLUSIONS
  Invasive aspergillosis affecting the mediastinum can progress and affect the heart tissues. The use of omeprazole may be associated with the undetectable voriconazole serum levels.
authors.affiliation: Servicio de Microbiología Clínicay Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Departamento de Medicina, Universidad Complutense, Madrid, España.
authors.forename: Alia
authors.initials: A
authors.lastname: Eworo
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Juan F
authors.initials: JF
authors.lastname: Yáñez
authors.forename: Jesús
authors.initials: J
authors.lastname: Palomo
authors.forename: Pedro
authors.initials: P
authors.lastname: Guembe
authors.forename: Jorge
authors.initials: J
authors.lastname: Roda
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.forename: Jesús
authors.initials: J
authors.lastname: Guinea
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D000077336:Caspofungin; D003131:Combined Modality Therapy; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D003646:Debridement; D054714:Echinocandins / Q000627:therapeutic use; D004696:Endocarditis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000209:etiology*; D006084:Graft Rejection / Q000188:drug therapy; D006325:Heart Atria / Q000382:microbiology; D016027:Heart Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D055666:Lipopeptides; D008172:Lung Diseases, Fungal / Q000209:etiology / Q000382:microbiology; D008875:Middle Aged; D009853:Omeprazole / Q000494:pharmacology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D011655:Pulmonary Embolism / Q000209:etiology; D011743:Pyrimidines / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D014230:Triazoles / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D014261:Tricuspid Valve / Q000382:microbiology / Q000601:surgery; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D007166:Immunosuppressive Agents; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole; D009853:Omeprazole