A69-42 Successful Lung Transplantation in a Patient With Mycetoma and Aspergillosis, Coccidiomycosis, and Pseudomonas Aeruginosa Co-infections

Abstract Introduction Fibrocystic sarcoidosis can be complicated by opportunistic fungal infections with reports of incidence ranging between 0.9% and 1.4% and most commonly aspergillosis. While successful lung transplantation in patients with aspergillomas have been described anecdotally in the literature, little is known in the context of Coccidiomycosis and Pseudomonas aeruginosa co-infections and previous studies have discouraged this practice due to risk of fatal fungal infections post-transplant and chronic lung allograft dysfunction. Case Description We present a 45-year-old male with stage IV sarcoidosis, complicated by right upper lobe aspergilloma, and Coccidiomycosis and Pseudomonas aeruginosa co-infections who underwent double lung transplantation. Initially presenting to another medical center for acute respiratory failure with hypoxemia (SpO2 70%), he was referred to our center for evaluation for lung transplant. CT chest scan demonstrated a mycetoma in the right upper lobe described as a round intracavitary mass. Two bronchoscopies with transbronchial biopsy and bronchoalveolar lavage (BAL) were performed at another center to confirm sarcoidosis and for infectious workup, which revealed Aspergilla flavus and Coccidioides immitis co-infections. Next-generation PCR testing of several sputum cultures confirmed A. flavus, C. immitis, and Pseudomonas aeruginosa. He presented multiple times for acute on chronic respiratory failure, with increasing cough, and development of hemoptysis leading to lung transplantation. Intraoperatively, significant pleural adhesions were observed bilaterally, and pleural spaces were irrigated with amphotericin B liposome solution prior to implantation of donor lungs. Prior to transplant, he was on amphotericin B liposome IV, which was continued both IV and inhaled for up to one-week post-transplant in addition to continued voriconazole IV. Negative sputum culture was achieved, and cough and hemoptysis ceased post-transplant. Discussion Patients with mycetoma and Aspergillosis, Coccidiomycosis, and P. aeruginosa co-infections can receive lung transplantation, provided that there is sufficient technical expertise to explant the infected lung with minimal chance of chest wall contamination, and aggressive antifungal therapy is used post-transplantation. This abstract is funded by: None