Respiratory Failure due to Possible Donor-DerivedSporothrix schenckiiInfection in a Lung Transplant Recipient

Abstract

Background. De novo and donor-derived invasive fungal infections (IFIs) contribute to morbidity and mortality in solid organ transplant (SOT) recipients. Reporting of donor-derived IFIs (DDIFIs) to the Organ Procurement Transplant Network has been mandated since 2005. Prior to that time no systematic monitoring of DDIFIs occurred in the United States. Case Presentation. We report a case of primary graft dysfunction in a 49-year-old male lung transplant recipient with diffuse patchy bilateral infiltrates likely related to pulmonary Sporothrix schenckii infection. The organism was isolated from a bronchoalveolar lavage on the second day after transplantation. Clinical and radiographic responses occurred after initiation of amphotericin B lipid formulation. Conclusion. We believe that this was likely a donor-derived infection given the early timing of the Sporothrix isolation after transplant in a bilateral single lung transplant recipient. This is the first case report of sporotrichosis in a lung transplant recipient. Our patient responded well to amphotericin induction therapy followed by maintenance therapy with itraconazole. The implications of donor-derived fungal infections and Sporothrix in transplant recipients are reviewed. Early recognition and management of these fungi are essential in improving outcomes.

Sporotrichosis In Immunocompromised Hosts

“…On the second day of transplantation, while on induction of immunosuppression with high dose methylprednisolone, tacrolimus, and mycophenolate mofetil, he presented pulmonary diffuse patchy bilateral infiltrates and S. schenckii was isolated from bronchoalveolar lavage. Treatment with amphotericin B lipid formulation followed by itraconazole maintenance therapy was successful [126]. Rare cases of sporotrichosis in patients with hematologic cancer have also been described.…”

“…However, most cases presented a good outcome when provided with more prolonged and higher doses of antifungal treatment than used in immunocompetent hosts. In this scenario, the drug of choice should be guided by the severity of the disease, with initial therapy with amphotericin B being frequently required [114,116,117,125,126,127,128,130,132].…”

Sporotrichosis in renal transplant patients: two case reports and a review of the literature

“…Candida species, Aspergillus species and Cryptococcus neoformans are most frequently isolated [9]. Sporotrichosis is rare in transplant patients, and in these patients, it occurs mostly in renal transplant recipients, although Bahr et al [10] reported sporotrichosis in a lung transplant patient and da Silva et al [11] recently reported the first case of sporotrichosis in a liver transplant recipient. After a thorough search of the relevant literature our case (case 2) is only the second reported case of meningeal sporotrichosis in a renal transplant recipient, the first case was reported in 1987 by Gullberg et al [4].…”

Fatal pulmonary sporotrichosis caused by Sporothrix brasiliensis in Northeast Brazil

“…Primary pulmonary form presents clinically similar to tuberculosis, with fatigue, weight loss, cough, low fever, mediastinal lymphadenitis, cavitation, fibrosis and rarely massive hemoptysis. Apical lesions occur in 85% of cases [7,11,32], whereas in multifocal sporotrichosis, pulmonary involvement is secondary to spread of infection, acquired after traumatic injury where bibasal or diffuse reticulonodular infiltrate are more frequently found. It presents with non-cavitary lesions and usually occurs in immunosuppressed patients [32].…”