title: Respiratory Failure due to Possible Donor-Derived Sporothrix schenckii Infection in a Lung Transplant Recipient.
abstract: Background. De novo and donor-derived invasive fungal infections (IFIs) contribute to morbidity and mortality in solid organ transplant (SOT) recipients. Reporting of donor-derived IFIs (DDIFIs) to the Organ Procurement Transplant Network has been mandated since 2005. Prior to that time no systematic monitoring of DDIFIs occurred in the United States. Case Presentation. We report a case of primary graft dysfunction in a 49-year-old male lung transplant recipient with diffuse patchy bilateral infiltrates likely related to pulmonary Sporothrix schenckii infection. The organism was isolated from a bronchoalveolar lavage on the second day after transplantation. Clinical and radiographic responses occurred after initiation of amphotericin B lipid formulation. Conclusion. We believe that this was likely a donor-derived infection given the early timing of the Sporothrix isolation after transplant in a bilateral single lung transplant recipient. This is the first case report of sporotrichosis in a lung transplant recipient. Our patient responded well to amphotericin induction therapy followed by maintenance therapy with itraconazole. The implications of donor-derived fungal infections and Sporothrix in transplant recipients are reviewed. Early recognition and management of these fungi are essential in improving outcomes.
authors.affiliation: Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 250, Minneapolis, MN 55455, USA.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Bahr
authors.affiliation: Department of Medicine, University of Minnesota, 401 East River Parkway, VCRC 1st Floor, Suite 131, Minneapolis, MN 55455, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Janssen
authors.affiliation: Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 276, Minneapolis, MN 55455, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Billings
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 207, Minneapolis, MN 55455, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Loor
authors.affiliation: Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 250, Minneapolis, MN 55455, USA.
authors.forename: Jaime S
authors.initials: JS
authors.lastname: Green