SUCCESSFULLY TREATED INVASIVE PULMONARY ASPERGILLOSIS ASSOCIATED WITHSMOKING MARIJUANA IN A RENAL-TRANSPLANT RECIPIENT

Invasive pulmonary aspergillosis (IPA) is often a lethal entity in tra nsplant recipients (up to 90%). We report the successful treatment of a case of IPA in a renal transplant recipient whose only risk for expo sure was habitual marijuana smoking, Although marijuana smoking has be en linked to the development of IPA in patients immunosuppressed for a variety of reasons, this case is the first report involving a solid o rgan transplant recipient. The patient's clinical course and treatment are described and the literature is reviewed with respect to environm ental and patient risk factors. In this case, IPA was associated with the patient's heavy usage of marijuana during the immediate posttransp lant period, Treatment was successful and included the experimental am photericin product amphotericin B colloidal dispersion. Contemporaneou s exposure to a large amount of inocula of Aspergillus within 30 days of receiving high doses of steroids appeared to be the most important factor that predisposed this patient to IPA. Transplant recipients sho uld be specifically proscribed from marijuana use during periods of hi gh steroid administration.