lung transplant exciting cases in transplant infectious disease presented by silvia vidal on behalf...

LUNG TRANSPLANTExciting Cases in Transplant Infectious Disease

Presented by Silvia Vidal on behalf of her mentor Clarisse Machado

CLINICAL CASE

FFL, 59 yo, male, emphysema (listed since jun/2013) Bronchopulmonary allergic aspergillosis since 2012 (sputum and

positive serology (ID/CIE+) Lung volume reduction surgery (bilateral bullectomy) - 2002 Deep vein trombosis 2002 and 2007 – alveolar hemorrhage inferior

vena cava filter and prophylaxis with enoxaparin intermittent claudication Arterial hypertension Respiratory colonization: Aspergillus spp./ Stenotrophomonas

maltophilia Cardiac catheterization (dec/12): obstructive lesion (70%) left marginal

artery branch

CLINICAL CASE Bilateral lung transplant without CPB 17/mar/15; Ischemic time right lung

5h:45min and left lung 9hours; norepinephrine 0,2mcg/kg/min

ICU discharge PO 4

ATM: Micafungin, Piperacilin/Tazobactam, sulfametoxazole-trimethropim (donor BAL culture: E.faecalis, Staphylococcus coagulase negative and yeast; recipient cultures: negative) Donor lymphonode: caseous necrosis with fungal form suggestive of

Histoplasma spp.

Immunosuppression therapy: Tacrolimus + Azathioprine + prednisone

PO 8: pancytopenia (Hb 9,3 leuk 2900 Plt 93000 RNI 1,9) micafungin to itraconazole, vitamin K and suspension of azathioprine

Chest X-ray: normal

CLINICAL CASE

PO 9 severe sepsis septic shock: blood and BAL cultures taken Bronchoscopy (thick mucous secretion adhered to the bronchial

mucosa ) ATM switched to Meropenem, Teicoplanin, levofloxacin and liposomal amphotericin

Hb 7.8 leuk 2100 (after filgastrim) Plt 21000

PO 10: Blood transfusion and Colistin clinically stable for 48h PO 12: acute respiratory failure alveolar hemorrhage ICU

death 1h after admission

X-RAY 9TH PO

X-RAY 11TH PO

NECROPSY

Pneumonia and acute myocardial infarction

LBA e HMC (27/mar/15 – post-mortem results): Trichosporon asahii and K.pneumoniae Hodge+