Invasive Aspergillosis in a Renal Transplant Recipient Successfully Treated with Interferon-Gamma

Abstract

Invasive aspergillosis is a serious complication of solid organ transplantation. An early diagnosis is hampered by the lack of reliable serum markers and, even if appropriately diagnosed and treated with current antifungal agents, has a high mortality rate. We report a case of invasive pulmonary and cerebral aspergillosis in a renal transplant patient treated with IFN-γ in conjunction with combination anti-fungal therapy for six weeks in whom complete resolution of the fungal infection was achieved. Renal function remained intact throughout the treatment period. Surveillance CT scans of the chest and head showed resolution of prior disease but revealed a new left upper lobe mass four months after completion of treatment with IFN-γ. Biopsy of the lesion was positive for primary lung adenocarcinoma, for which she underwent left upper lobe resection. The pathology report confirmed clear surgical margins and lymph nodes and no evidence of fungal hyphae. IFN-γ should be considered early in the management of invasive aspergillosis in renal transplant patients. To date, allograft rejection has not been encountered.

Immunotherapy for Fungal Infections

“…The adjunctive immunotherapy with recombinant IFN-γ partially restored cell-mediated immunity and enhanced antifungal immunity in a prospective case series describing eight patients with invasive Candida or Aspergillus infections [104]. Other case reports have described the successful treatment of invasive aspergillosis with the combination of IFN-γ and antifungal therapy [105][106][107][108]. Adjunctive therapy with interferon-γ, GM-CSF or G-CSF showed good functional outcome in a case of Scedosporium apiospermum otomastoiditis and in a case of Mucor sinusitis and orbital cellulitis refractories to treatment with conventional antifungals [109].…”

Optimizing Outcomes in Immunocompromised Hosts: Understanding the Role of Immunotherapy in Invasive Fungal Diseases

“…Recombinant IFN-γ treatment in patients with invasive Candida and/or Aspergillus infections partially restored immune function, as characterized by an increased HLA-DR expression in those patients and an enhanced production of pro-inflammatory cytokines involved in antifungal defense ( Delsing et al, 2014 ). IFNγ is also used in the treatment of recalcitrant aspergillosis ( Kelleher et al, 2006 ; Bandera et al, 2008 ; Estrada et al, 2012 ). Further large-scale clinical studies to assess the potential clinical benefit of IFNγ is needed, but the cost of the drug remains a major concern.…”

Severe infections in kidney transplanted children

“…Early diagnosis is challenging, with cultures from bronchial lavage lacking sensitivity and the still unclear role of the galactomannan test [9]. In these cases the treatment of choice remains a 12 week course of voriconazole [10].…”

“…The CMV co-infection is an interesting trait in our case. Even though a correlation between the immunomodulating effect of CMV and Aspergillus infection has not been thoroughly studied, other cases of coinfection have been previously reported [10].…”