Simultaneous Lung and Liver Aspergillus in a Kidney Transplant Recipient

Jihye Park; Eunah Hwang; Sungbae Park; Hyunchul Kim; Hyoungtae Kim

doi:10.4285/jkstn.2012.26.3.202

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Park, Hwang, Park, Kim, and Kim: Simultaneous Lung and Liver Aspergillus in a Kidney Transplant Recipient

Case Report

The Journal of the Korean Society for Transplantation

The Journal of the Korean Society for Transplantation 2012; 26(3): 202-206.

Published online: 28 September 2012

DOI: https://doi.org/10.4285/jkstn.2012.26.3.202

Simultaneous Lung and Liver Aspergillus in a Kidney Transplant Recipient

Jihye Park, M.D.¹, Eunah Hwang, M.D.^1,², Sungbae Park, M.D.^1,², Hyunchul Kim, M.D.^1,², Hyoungtae Kim, M.D.^2,³

¹Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

²Keimyung University Kidney Institute, Daegu, Korea.

³Department of Surgery, Keimyung University School of Medicine, Daegu, Korea.

Corresponding author (eahwang@gmail.com)

Received 9 November 2011 Accepted 19 June 2012

Abstract

Invasive opportunistic infection by Aspergillus fungus is life-threatening for kidney transplant recipients. The occurrence of aspergillosis by hematogenous dissemination can affect multiple organs. Despite having a lower incidence rate relative to bacterial or viral infections in kidney transplant recipients, fungal infections produce the highest number of mortalities. We report a simultaneous case of invasive aspergillosis in the lung and liver of a 52-year-old female patient who underwent living donor kidney transplant. She suffered massive blood loss and high-volume transfusions due to postoperative bleeding. One month after transplantation, she reported intermittent coughing without febrile sensation. Computed tomography revealed nodules on the right and left upper lobes of the lung and multiple cystic liver lesions. Based on pathologic findings and culture from aspirate, she was diagnosed with invasive aspergillosis involving the liver and lung. After a 4 month voriconazole treatment the nodules in the lung and liver disappeared.

Keywords: Kidney transplantation, Fungal, Aspergillus

Figures and Tables

Fig. 1

Nodular opacities were newly developed in left and right upper lung.

Fig. 2

(A) Chest computed tomography (CT) revealed contrast enhanced nodular consolidations in right upper lobe apical and left upper lobe apicoposterior segment. (B) Abdominal CT revealed multiple cystic lesions with enhancing wall in right and left hepatic lobes.

Fig. 3

(A) Lung biopsy. Many fungal organisms were identified in inflammatory and necrotic areas (Gomori-methenamine silver stain, ×400). (B) Liver aspiration. Delicate blue hyphae and fruiting structures were identified in cystic lesions (Lactophenol cotton blue stain, ×400).

Fig. 4

Subpleural lung nodules (A) and multiple hepatic abscesses (B) were not detected after treatment with voriconazole for 4 months.

References

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