AUREOBASIDIUM PNEUMONIA IN A POST LIVER-TRANSPLANT RECIPIENT - A CASE-REPORT

This is the first report of Aureobasidium (A.) pullulans as an, opport unistic pulmonary infection in a liver transplant recipient. A 46-year -old caucasian man. had an orthotopic liver transplant in 1988. His li ver disease was primary sclerosing cholangitis. He required 2 subseque nt liver re-transplants for primary graft non-function and acute rejec tion. The patient had been living in the California desert for two mon ths prior to admission and presented with ventilator-dependent acute r espiratory failure and hemodialysis-dependent acute renal failure. Ima ging studies revealed severe bilateral infiltrates. His initial bronch oalveolar Lavage (BAL) and brushings gl ew A. pullulans. Pancultures, including sputum and throat cultures, were negative for bacterial or o ther fungal organisms. The patient responded to pulmonary support and aggressive systemic antifungal agents while being maintained on cyclos porine and prednisone for immunosuppression, He was discharged to a sh illed nursing facility 37 days after hospitalisation. Delay in dischar ge was primarily due to severe malnutrition and renal impairment. Oppo rtunistic fungal infections continue to be a major problem in. immunos uppressed patients including liver transplant recipients. Here we repo rt a pulmonary infection with. Coccidioides (C.) immitis and superinfe ction with A. pullulans Opportunistic infections such as A. pullulans can be treated successfully with systemic fluconazole when, amphoteric in B is not well tolerated.