Early-Onset Invasive Pulmonary Aspergillosis in a Liver Transplant Patient: A Case Report

Abstract

Invasive pulmonary aspergillosis (IPA) in liver transplant patients remains rare but exceedingly fatal. The diagnostic challenges associated with this condition are compounded by its infrequent onset within the first two weeks following transplantation. Moreover, therapeutic management is complex due to the intricate drug interactions between triazole antifungals and calcineurin inhibitor immunosuppressants. We present the case of a 63-year-old male who underwent uncomplicated liver transplantation (LT) and developed early-onset IPA. Despite maximal efforts, the patient expired. This report aims to underscore the vital importance of timely diagnosis and therapy in preventing the insidious progression of invasive disease and subsequent mortality.

Keywords: antifungal agents; clinical case report; id critical care; invasive fungal infection; invasive pulmonary aspergillosis; liver transplantation.

Figure 1. Chest CT

Chest CT obtained on POD nine demonstrates consolidative opacities (arrows) throughout both lungs and moderate, diffuse bronchial wall thickening with scattered endobronchial secretions consistent with widespread multifocal pneumonia and bronchopneumonia

Figure 2. Right-mainstem bronchoscopy

The image obtained on POD nine demonstrates a screen capture from diagnostic flexible bronchoscopy at the right-mainstem bronchus. Findings were consistent with general inflammation with erythema, nodularity, and scattered pseudomembranous lesions (arrows) with copious thick purulent secretions in proximal airways, suggestive of bronchopneumonia. *, carina; L, left mainstem bronchus; R, right mainstem bronchus