A case of successful resection after long-term medical treatment of invasive pulmonary aspergillosis following living donor liver transplantation.

Invasive pulmonary aspergillosis (IPA) occurs in 1.5 to 10% of liver transplant recipients. Of the fungal infections, IPA is the most difficult to treat and the most frequently life-threatening. However, the best treatment strategy remains controversial. The patient was a 53-year-old woman who underwent living donor liver transplantation (LDLT) because of subacute fulminant hepatic failure due to autoimmune hepatitis. Aspergillus fumigatus was detected in the sputum taken intraoperatively by bronchial suction. A computed tomogram of the lung 7 days after LDLT showed fungal balls in the left lung. IPA was diagnosed. Since the patient suffered from pulmonary edema postoperatively and fungal balls occupied a greater part of the left lung, conservative therapy using micafungin, amphotericin B, and itraconazole was first selected. However, the fungus balls did not completely disappear. Moreover, brain abscess probably resulting from IPA dissemination was detected. Lung resection was performed as reduction surgery, and salvage treatment using voriconazole was done for a brain abscess. Septate hyphae of Aspergillus fumigatus were identified in the lung specimen. We concluded that for patients with IPA after LDLT, pulmonary resection should be done as soon as possible before deterioration of IPA and complication due to acute cellular rejection.