Atypical presentation of invasive pulmonary aspergillosis in a liver transplant recipient.

BACKGROUND: Invasive pulmonary aspergillosis (IPA) occurs in 1% to 8% of liver transplant recipients. It is one of the most frequent life-threatening fungal infections in immunocompromised patients, with a reported mortality rate of approximately 60%. CASE REPORT: We present the case of an 18-year-old man who underwent liver transplantation (LT) in January 2004 due to multifocal hepatoblastoma (HBL) and was diagnosed with IPA 3 years after LT. Because of a single pulmonary nodule of the left lung found in chest computed tomography (CT) 4 weeks after LT, the patient received adjuvant chemotherapy. A control chest CT performed in September 2004 did not reveal any pathological changes. A subsequent examination in May 2006 demonstrated a pulmonary lesion situated in the 10th segment of the left lung, which was confirmed by PET in October 2006. In March 2007 the patient underwent videothoracoscopic complete resection of the lesion. Histopathological examination revealed IPA and subsequent 3-month antifungal treatment with voriconazole resulted in 5 years of recurrence-free survival.
CONCLUSIONS: We conclude that any stable solitary pulmonary lesion in a transplant recipient needs to be resected in order to allow a definitive diagnosis and prevent disease dissemination such as IPA in our patient.