Rare mycotic complications following liver transplant

Abstract

A total of 420 liver transplants were carried out at the transplant centre in Brno between 2 February 1983 and 31 December 2011. We observed an unusual and serious mycotic infection, which was not caused by Candida or aspergillus, in a total of five patients. We found one case each of Cladophialophora bantiana and Fonsecaea compacta infection. In three cases the infection was caused by Cryptococcus neoformans. Three patients (3/5 = 60%) died of the aforementioned infection. The authors describe the case of a 44-year old man with abscesses of the lungs and brain, caused by black fungus (Cladophialophora bantiana). Despite the application of the full spectrum of antimycotic therapy and surgical procedures, the infection continued to progress, resulting in the death of the patient. The second patient, a 54-year old woman, had developed recidivising skin infiltrations, which were examined from a histological, microscopic and cultivatory point of view, with the presence of Fonsecaea compacta demonstrated. While repeated surgical interventions were required to remove deposits following recidivism, only the introduction of antimycotic therapy led to its complete disappearance. The patient has shown no signs of infection for seven years. The authors further describe the case of a 56-year old man with a haematogenic spread of mycotic infection of the skin caused by Cryptococcus neoformans. In this case, the surgical removal of skin deposits and long-term antimycotic therapy led to the regression of the infection and stabilisation of the patient. In the fourth case study, the authors describe the case of a 56-year old man after orthotopic liver transplantation and with early onset encephalitis, bilateral bronchial pneumonia, which led to the death of the patient on the 40th day following transplant. The etiology of the infection (Cryptococcus neoformans) was demonstrated following post mortem microscopic examination. The fifth patient was a 31-year old man with primary biliary cirrhosis, on whom a liver transplant was performed, accompanied by the reconstruction of the biliary tracts using a Roux loop. The operation and early post-operative period passed without complications. From the 12th day following surgery the patient suffered loss of consciousness and Cryptococcus neoformans was found in the lumbar puncture. Despite the introduction of therapy, the patient died of brain oedema within three months.