ABSTRACT
BACKGROUND: Pulmonary invasive fungal disease is a frequent complication in patients with hematologic malignancies. Surgical resection in addition to antifungal therapy is an option for selected cases but often feared because of immunosuppression. METHODS: We analyzed the outcome of 71 patients undergoing lung resection for pulmonary invasive fungal disease. Most patients had leukemia, 44 underwent high-dose chemotherapy, and 18 underwent stem cell transplantation. RESULTS: On the day of surgery, 44 patients were neutropenic, and 41 had a platelet count < 50 × 109/L. Forty-five nonanatomic (atypical) resections and 26 lobectomies were performed. Fungal infection was histologically proven in 53 patients. Reoperation was needed in four patients (bronchial stump dehiscence, persistent air leak, chylothorax, and seroma). Minor complications at the site of surgery occurred in 14 patients. In only two, there was an uncontrolled disseminated fungal infection. Overall, mortality at 30 days was 7% (five of 71). Long-term survival was mainly influenced by the underlying hematologic disease. CONCLUSIONS: Lung resection is a therapeutic option for hematologic patients with pulmonary fungal infection. Despite immunosuppression, the perioperative morbidity and mortality is acceptable, and, therefore, the prognosis is not determined by the surgical intervention.
Subject(s)
Aspergillosis/surgery , Hematologic Neoplasms/complications , Immunocompromised Host , Lung Diseases, Fungal/surgery , Lung/surgery , Pneumonectomy/methods , Adolescent , Adult , Aged , Antifungal Agents/therapeutic use , Aspergillosis/complications , Aspergillosis/drug therapy , Child , Combined Modality Therapy , Female , Follow-Up Studies , Hematologic Neoplasms/mortality , Hematologic Neoplasms/therapy , Humans , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/drug therapy , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Rate/trends , Switzerland/epidemiology , Young AdultABSTRACT
We report the case of a 65-year-old male patient who died from lethal Aspergillus fumigatus endomyocarditis and multiple cerebral septic emboli 6 months after cardiac transplantation. This complication developed 4 weeks after diagnosis of bilateral pulmonary aspergillosis, which was immediately treated by surgical removal and intravenous amphotericin B. Preceding colonization with Aspergillus spp was not identified. Primary cytomegalovirus infection (donor+/recipient-) and toxoplasmosis reactivation (donor+/recipient+) occurring at 1 and 2 months post-transplantation were successfully treated.
Subject(s)
Aspergillosis/etiology , Aspergillus fumigatus , Brain Abscess/microbiology , Endocarditis, Bacterial/microbiology , Heart Transplantation/adverse effects , Myocarditis/microbiology , Aged , Aspergillosis/pathology , Aspergillosis, Allergic Bronchopulmonary , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/etiology , Endocarditis, Bacterial/pathology , Fatal Outcome , Heart Transplantation/pathology , Humans , Male , Myocarditis/pathology , Time Factors , Toxoplasmosis/drug therapy , Toxoplasmosis/etiologyABSTRACT
Outpatient CT-guided radiofrequency ablation (RFA) of a pulmonary metastasis followed by surgical resection and histopathological analysis was performed in a 72-year-old lady suffering from a peritoneal leiomyosarcoma. Histological workup 3 weeks post-ablation showed complete devitalization of the metastasis. This case report demonstrates that complete thermal destruction of a pulmonary metastasis by percutaneous image-guided RFA is possible.
