title: Invasive cardiac aspergillosis after orthotopic liver transplantation.
abstract: Invasive aspergillus infection occurs in 5 - 42 % of liver-transplanted recipients and is a dangerous complication, associated with high mortality if untreated. However, the early diagnosis of invasive aspergillosis can be elusive, as clinical signs are unspecific and the pathogenic agent is difficult to demonstrate. We here report about a 58-year-old man with acute liver failure caused by newly diagnosed chronic hepatitis B infection who underwent liver transplantation. The postoperative course was uneventful, and the patient was discharged after 30 days. After 105 days the patient was readmitted because of fever, recurrent chest and abdominal pain. Computed tomography revealed a cardiac lesion; other diagnostic steps including bone-marrow and endomycordial biopsy, virological and microbiological investigations gave no clear findings. To exclude a malignant process, thoracotomy with mass and simultaneous lower left lobe resection were performed. Histopathological findings revealed an invasive perimyocardial aspergillosis. Immediate intravenous therapy with voriconazole and caspofungin was initiated and monitoring of the mass was performed with transesophageal echocardiography and Cardio-MRI. Due to slightly increase of the lesion, medication was switched to posaconazole and caspofungin. Under this dual fungal treatment the lesion regressed and the patient could be discharged after two months in good clinical condition. Frequent Cardio-MRI scan after discharge showed further mass-regression. Therefore antifungal treatment was switched to oral posaconazole mono-therapy. After one year, complete reduction of the mass was achieved and antifungal therapy was discontinued. Recent diagnostic imaging follow-up showed no pathological finding.
authors.affiliation: Department of Visceral, Transplantation, Thorax and Vascular Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Wiltberger
authors.affiliation: Department of Visceral, Transplantation, Thorax and Vascular Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schmelzle
authors.affiliation: Department of Medicine, Dermatology and Neurology, Division of Infectious Diseases and Tropical Medicine, Clinic of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schubert
authors.affiliation: Department of Medicine, Dermatology and Neurology, Division of Infectious Diseases and Tropical Medicine, Clinic of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Lübbert
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Brandmaier
authors.affiliation: Department of Medicine, Dermatology and Neurology, Division of Infectious Diseases and Tropical Medicine, Clinic of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Berg
authors.affiliation: Department of Medicine, Dermatology and Neurology, Division of Cardiology and Angiology, University of Leipzig, Leipzig, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Pfeiffer
authors.affiliation: Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Rodloff
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: F-W
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Department of Visceral, Transplantation, Thorax and Vascular Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Jonas
mesh_terms: D000208:Acute Disease; D000077336:Caspofungin; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D006509:Hepatitis B / Q000601:surgery*; D006801:Humans; D055666:Lipopeptides; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D008168:Lung / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology; D055732:Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D054714:Echinocandins; D055666:Lipopeptides; D014230:Triazoles; C101425:posaconazole; D000077336:Caspofungin