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+