Concurrent Mold, Mycobacterial, and Viral Infections in a Hematopoietic Stem Cell Transplant Recipient Undergoing Lung Transplantation for Graft-Versus-Host Disease - PubMed
8 hours ago
- #Hematopoietic Stem Cell Transplant
- #Opportunistic Infections
- #Lung Transplantation
- HSCT recipients are at high risk for opportunistic infections due to immunosuppression and GvHD.
- A 42-year-old woman post-HSCT for AML developed concurrent pulmonary infections with molds (Microascus spp., Aspergillus calidoustus) and Mycobacterium chimaera, later complicated by RSV.
- Initial therapy included voriconazole, amphotericin B, and macrolide-based regimen for NTM, but required modifications due to drug resistance and hepatotoxicity.
- Recurrent fungal infection led to prolonged antifungal therapy with adjunctive inhaled amphotericin B and terbinafine.
- Progressive bronchiolitis obliterans necessitated bilateral lung transplantation, with explant pathology confirming NTM and mold infections.
- Post-transplant prophylaxis with voriconazole, rifabutin, azithromycin, and inhaled amikacin prevented recurrence, with patient stable at 6-month follow-up.
- The case highlights the complexity of overlapping infections in HSCT recipients, emphasizing individualized, multidisciplinary care, therapeutic drug monitoring, and adjunctive inhaled antifungals.