Late Aspergillus fumigatus endomyocarditis with brain abscess as a lethal complication after heart transplantation

Rueter, Florian; Hirsch, Hans H.; Kunz, Franziska; Buser, P; Habicht, James; Moch, Holger; Flückiger, Ursula; Zerkowski, Hans‐Reinhard

doi:10.1016/s1053-2498(02)00426-6

Cited by 19 publications

(18 citation statements)

References 7 publications

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“…Aziz et al (10) have suggested that intramyocardial abscesses may occur from the myocardial wall being damaged by prior biopsies allowing for seeding of the ventricle to take place. However, in our case and the other case reports (1, 3, 4), the abscesses were in the lateral wall of the left ventricle, a site not subject to biopsy, and we cannot explain why the MRSA settled in the myocardium.…”

Section: Discussioncontrasting

confidence: 84%

“…They did not report whether the organism was MRSA. Rueter et al (3) report a case of a 65‐year‐old man with A. fumigatus myoendocarditis involving the mitral valve and the myocardium, with multiple cerebral septic emboli, resulting in death, occurring 6 months after transplantation. Khoo et al (4) describe a 51‐year‐old man who developed a febrile illness 33 months after the transplant, with S. aureus being isolated from blood cultures, but do not describe whether it was methicillin resistant.…”

Section: Discussionmentioning

confidence: 99%

“…It appears that multiple endomyocardial biopsies may predispose patients to endocarditis. However, endomyocardial abscesses in heart transplant recipients are very uncommon, with only 3 other cases described in the literature (1, 3, 4). S. aureus was responsible for 2 of the cases and A. fumigatus for the other case, with all cases having abscesses contained within the left ventricle and all patients dying (1, 3, 4).…”

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confidence: 99%

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Community‐acquired methicillin‐resistant Staphylococcus aureus endomyocardial abscesses in a heart transplant recipient

Oyler¹,

Riveros-Angel²,

Shaw³

et al. 2009

Transplant Infectious Dis

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Infective endocarditis is more common in heart transplant recipients than in the general population. We report a case of endomyocardial abscesses and sepsis syndrome due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in a heart transplant recipient with a negative transesophageal echocardiogram. The suspected portal of entry for this MRSA infection was through infected herpes zoster lesions. This case demonstrates the difficulty of diagnosing endomyocardial abscesses in heart transplant patients.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Community‐acquired methicillin‐resistant Staphylococcus aureus endomyocardial abscesses in a heart transplant recipient

Oyler¹,

Riveros-Angel²,

Shaw³

et al. 2009

Transplant Infectious Dis

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“…A literature review revealed a total of 22 patients who had endocarditis following heart transplant (Table 2) (3–14). Six cases had endocarditis caused by S. aureus , 3 by S. epidermidis , and 2 cases each had E. faecalis and fungal endocarditis.…”

Section: Resultsmentioning

confidence: 99%

“…A case series of 6 patients with infective endocarditis (IE) following cardiac transplant described a mortality of 67% (2). These and subsequent studies (3–14) have identified only 22 patients with endocarditis following heart transplant. With an experience this limited, clinical features such as anatomic location of infection, microbiology, factors associated with the development of infection, and infection outcome remain incompletely described.…”

mentioning

confidence: 99%

Infective endocarditis following orthotopic heart transplantation: 10 cases and a review of the literature

Sherman-Weber

Axelrod

Suh

et al. 2004

Transplant Infectious Dis

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Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipient

Goegele¹,

Ruttmann²,

Aranda-Michel³

et al. 2007

Wien Klin Wochenschr

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Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipientSir,We would like to report a case of infective endocarditis (IE) due to extended spectrum betalactamase (ESBL) producing Klebsiella terrigena. Klebsiella terrigena is a rarely encountered Gram negative rod and many microbiological laboratories still do not subtype Klebsiella to the species level. This is only the third reported case of IE due to ESBL producing Klebsiella, the second case in an adult and the first case in an organ recipient. Zimhony et al. reported on successful conservative therapy in an immuncompetent patient. However, in the immunocompromised host, a different management including surgery maybe is required [1]. Transplant recipient are at high risk for IE but still many cases are discovered at an advanced stage or post mortem [2][3][4][5][6][7][8][9][10][11][12]. In a series of 666 liver transplants performed during a 15 year period at our institution, we identified five patients with post mortem diagnosed IE. Fever, lassitude, and signs of inflammation can be absent in transplant recipients with infections and also can be present during acute rejection or other conditions of graft dysfunction.Our patient was a 45 year-old comatose, severe malnourished man with acute renal failure who underwent liver transplantation (LT) for chronic hepatitis C. The intraoperative course was unremarkable and transesophageal echocardiography for hemodynamic monitoring found all valves normal. Initial graft function was excellent. Perioperative prophylaxis included piperacillin/tazobactam, ciprofloxacin, vancomycin and liposomal amphotericin B. Sputum, throat swab and urine prior to LT grew ESBL producing Klebsiella and piperacillin/tazobactam was continued for 10 days, as the pathogen was reported to be sensitive. Immunosuppressive therapy included IL-2 receptor antagonist, mycophenolate-mofetil and steroids; tacrolimus was initiated on day 9 post LT (trough levels of 4-8 ng/ml). On day 24 he developed fever, and ertapenem (1 g daily) was added as Klebsiella was cultured from bronchial secretions. Subsequently the patient defervescenced. On day 48 post LT pneumonia was diagnosed on CT-scan. Empirical treatment included azithromycin, teicoplanin and meropenem with initial response. He clinically deteriorated and required ventilation. Multi-resistant coagulase negative staphylococci (MRCNS) were isolated from sputum and vancomycin was started, which was later changed to linezolid. Immunosuppression was tapered but the infection did not improve and graft dysfunction with cholestasis developed. Liver biopsy showed findings compatible with sepsis, however, mild rejection could not be ruled out. Graft function further worsened and bolused steroids were given without success. Immunosuppression was changed to low dose sirolimus (trough levels of < 5 ng/ml) monotherapy. On day 90 blood cultures became positive for MRCNS and vancomycin was again administered. Klebsiella spp. was isolated from sputum and...

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Late Aspergillus fumigatus endomyocarditis with brain abscess as a lethal complication after heart transplantation

Cited by 19 publications

References 7 publications

Community‐acquired methicillin‐resistant Staphylococcus aureus endomyocardial abscesses in a heart transplant recipient

Community‐acquired methicillin‐resistant Staphylococcus aureus endomyocardial abscesses in a heart transplant recipient

Infective endocarditis following orthotopic heart transplantation: 10 cases and a review of the literature

Fatal endocarditis due to extended spectrum betalactamase producing Klebsiella terrigena in a liver transplant recipient

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