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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+