FATAL ASPERGILLUS SEPSIS AFTER ORTHOTOPIC HEART-TRANSPLANTATION

In a 64-year-old man heart transplantation had been performed for isch aemic heart disease. 7 months later severe vascular disease in the tra nsplant necessitated a second transplantation. Both procedures had bee n performed under immunosuppression (cyclosporine, azathioprine, predn isolone, antithymocyte globulin), with a subsequent prednisolone maint enance dose of 10 mg daily. At first there were no complications, but 31 days after the re-transplantation atrial flutter developed. Althoug h this was quickly terminated by drugs, circulatory failure set in. Be cause of signs of infection (white blood cell count 29800/mu l, 17% st ab cells, C-reactive protein 24 mg/l) broad-spectrum antibiotics were administered, but without response. As a trial anti-rejection treatmen t was started (prednisolone 250 mg daily: antithymocyte globulin 100 m g daily for 4 days). When cytomegalovirus (CMV) infection was demonstr ated, ganciclovir and CMV hyperimmunoglobulin were administered and sl ow improvement was noted. The finding of Aspergillus in tracheal secre tion was interpreted as apathogenic colonization. The patient died fro m cardiorespiratory failure 57 days after the second transplantation. Autopsy revealed Aspergillus sepsis.