title: Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report.
abstract: BACKGROUND
  Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematologic malignancies. Acquired gastropulmonary fistula is a rare complication of IFI.
  
  
  METHODS
  We present a case history of a patient with malignant myeloma. She was treated with autologous stem cell transplantation and chemotherapy for three years. She had been treated with antifungal agents as well. Following a specific treatment, she developed an invasive fungal infection (IFI) of the left lung which had been complicated with left gastropulmonary fistula. The patient's general condition was deteriorating, so it was decided to perform a surgical intervention. At the first procedure, open-window thoracostomy was created in order to facilitate treatment by daily packing of the cavity. Four weeks after the thoracostomy, a thoracomyoplasty was performed to repair a gastropleural fistula. During the laparotomy, the gastric fundus was freed from adjacent tissues and repaired. Intrathoracic transposition of the latissimus dorsi and anterior serratus muscle flaps was performed simultaneously to create a new diaphragm. The open-window thoracostomy was left open due to some small bronchial fistulas. The thoracostomy opening healed spontaneously during the following six months.
  
  
  CONCLUSIONS
  We report what is, to the best of our knowledge, the first case of an invasive fungal infection (Geotrichum capitatum) successfully treated with intravenous amphotericin B, voriconazole, and surgery on infected soft tissues (organs) for a patient with multiple myeloma in prolonged neutropenia. The efficacy and safety of the surgery for infected soft tissues requires further evaluation.
authors.affiliation: Centre of General Thoracic Surgery, Vilnius University, Vilnius, Lithuania.|Centre of Cardiothoracic Surgery, Department of General Thoracic Surgery, Vilnius University Hospital Santariškių Klinikos, Vilnius, Lithuania.
authors.forename: Ričardas
authors.initials: R
authors.lastname: Janilionis
authors.affiliation: Centre of General Thoracic Surgery, Vilnius University, Vilnius, Lithuania.
authors.forename: Lina
authors.initials: L
authors.lastname: Lukoševičiūtė
authors.affiliation: Centre of Abdominal Surgery, Vilnius University hospital Santariškių Klinikos, Vilnius, Lithuania.
authors.forename: Virgilijus
authors.initials: V
authors.lastname: Beiša
authors.affiliation: Centre of Abdominal Surgery, Vilnius University hospital Santariškių Klinikos, Vilnius, Lithuania.
authors.forename: Valdemaras
authors.initials: V
authors.lastname: Jotautas
authors.affiliation: Hematology, Oncology and Transfusiology Centre; Vilnius University Hospital Santariškių Klinikos; Vilnius, Lithuania.
authors.forename: Roberta
authors.initials: R
authors.lastname: Petrauskaitė
authors.affiliation: Hematology, Oncology and Transfusiology Centre; Vilnius University Hospital Santariškių Klinikos; Vilnius, Lithuania.
authors.forename: Valdas
authors.initials: V
authors.lastname: Pečeliūnas
authors.affiliation: Hematology, Oncology and Transfusiology Centre; Vilnius University Hospital Santariškių Klinikos; Vilnius, Lithuania.
authors.forename: Renata
authors.initials: R
authors.lastname: Jucaitienė
keywords: acquired gastropulmonary fistula; invasive fungal infection after immunosuppresive chemotherapy; pulmonary resection