Native lung pneumonectomy for invasive pulmonary aspergillosis following lung transplantation: A case report

Pulmonary aspergillosis occurs most commonly as a consequence of immunosupp ression in recipients of pulmonary transplantation and is associated with a high mortality. It affects the native lung more commonly than the transpla nted lung in single lung transplant patients. Infection often progresses de spite aggressive medical therapy. The cornerstone of treatment of acute, se mi-invasive, and invasive pulmonary aspergillosis (IPA) is medical, with in travenous amphotericin B, and oral itraconazole either as isolated or combi ned therapy. While newer, and more expensive liposomal forms of amphoterici n B have been used to enhance tissue penetration and minimize renal toxicit y, an appreciable improvement in clinical outcome has not been reported. Th e role of surgery in localized pulmonary aspergillus infection is well reco gnized, but remains undefined in immunosuppressed patients. We report a cas e where a pneumonectomy was performed for progressive, refractory angioinva sive aspergillosis in a lung transplant recipient whose disease progressed despite conventional antifungal therapy.