ADJUVANT INTRAPLEURAL AMPHOTERICIN-B THERAPY FOR PULMONARY MUCORMYCOSIS IN A CARDIAC ALLOGRAFT RECIPIENT

Infectious complications after heart transplantation remain a major ca use of morbidity and mortality. While many viral, bacterial, and proto zoal infections can be successfully treated, fungal infections continu e to be challenging. Mucormycosis is a rare infection in heart transpl ant recipients; however, mortality is exceedingly high. We report a ca se of cavitary Rhizopus lung infection 2 months after cardiac transpla ntation. The infection was complicated by inadvertent exposure of the pleural cavity to the fungus during surgical resection. Therapy consis ted of standard systemic amphotericin B, surgical excision, and for th e first time, the use of adjuvant intrapleural amphotericin B. Cure wa s achieved with no clinical or radiological evidence of disease at 3 m onths follow-up. Rhizopus pulmonary infection is a rare complication o f cardiac transplantation. Treatment consists of the triad of systemic anti-fungal therapy, surgical resection, and control of any underlyin g predisposing diseases. Adjuvant intrapleural amphotericin B use coul d also be considered in patients with fungal pneumonias and evidence o f chest wall and/or pleural cavity involvement.