Acute myocardial infarction secondary to mucormycosis after lung transplantation

Abstract

We present a case of a 57-year-old man who underwent bilateral lung transplantation for idiopathic pulmonary fibrosis. His immediately post-operative course was complicated by fever and cardiac arrest. Despite supportive care and broad-spectrum antibiotics, he experienced continued clinical decline. Autopsy results indicated angioinvasive mucormycosis and coronary arteritis resulting in acute myocardial infarction as the cause of death.

Keywords: Idiopathic pulmonary fibrosis; Lung transplantation; Mucormycosis.

Fig. 1

Autopsy findings. Fig. 1A shows chest CT scan of the donor with evidence of debris in left main bronchus (left) and metallic debris extending into left lower lobe bronchi (right) concerning for foreign body aspiration. Fig. 1B shows necrotic skin lesions on the left chest wall extending on to the flank, indicative of invasive fungal infection. Fig. 1C shows hematoxylin & eosin (H&E) staining of lung allograft demonstrating delicate alveolar septae and intense capillary vascular congestion but no obvious fungal infection. Fig. 1D shows Grocott-Gomori's methenamine silver (GMS) stain of right mainstem bronchus with evidence of invasive fungal infection. Fig. 1E shows high power magnification of the bronchus reveals broad, sparsely septate thin walled hyphae consistent with Apophysomyces elegans. Fig. 1F shows H&E stain of aorta reveals aortitis with intramural thrombus (asterisk). Fig. 1G shows GMS stain of the aorta with evidence of angioinvasive fungal aortitis with near total thrombotic occlusion (asterisk). Fig. 1H shows gross cardiac autopsy reveals epicardial necrosis (black asterisk), left ventricular posterior-lateral wall necrosis (white asterisk) and Left anterior descending coronary artery occlusion (arrow). Thrombosis of LAD without plaque is consistent with septic embolization (insert). Fig. 1I shows GMS stain of epicardial coronary artery revealing angioinvasive coronary arteritis with thrombotic occlusion (asterisk).