Aspergillus granulosus femoral osteomyelitis in a cardiac transplant patient : first reported case and literature review
© The Author(s), 2024..
Aspergillus osteomyelitis is a rare complication of extrapulmonary invasive aspergillosis, which usually presents as spondylodiscitis. The clinical picture is usually paucisymptomatic and of long evolution, which leads to diagnostic difficulties, especially in immunosuppressed patients presenting a delayed systemic host response. We report a case of femoral osteomyelitis caused by Aspergillus granulosus in a heart transplant recipient successfully treated with a combined surgical and antifungal approach. A 65-year-old heart transplant male presented with left knee pain lasting 3 months. X-ray and magnetic resonance imaging identified a lesion with aggressive characteristics at the distal third of the left femur, due to which the patient underwent excisional surgery. Aspergillus granulosus was cultured from the removed material and antifungal treatment with oral isavuconazole was started. Chest imaging excluded pulmonary aspergillosis, while the positron emission tomography/computed tomography (PET/CT) identified a remnant of a prosthetic vascular graft sewn to the proximal third of the right axillary artery, through which a catheter-based micro-axial left ventricular assist device was implanted previously as bridge to transplant therapy. The patient presented a rapid clinical improvement with complete functional recovery following the surgical treatment and the antifungal therapy and finally underwent surgical removal of the residual vascular graft. This is the first reported episode of long bone osteomyelitis due to A. granulosus that occurred in a heart transplant recipient without pulmonary infection and was successfully treated with isavuconazole. The PET/CT was useful in supporting the diagnostic process and follow-up. Cryptic fungal species can cause invasive infections, particularly in immunocompromised patients. Molecular methods are crucial in fungal identification.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
|---|---|
| Enthalten in: |
Therapeutic advances in infectious disease - 11(2024) vom: 19. Jan., Seite 20499361241231482 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Giacinta, Alessandro [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Aspergillus granulosus |
|---|
| Anmerkungen: |
Date Revised 17.02.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.1177/20499361241231482 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368519996 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368519996 | ||
| 003 | DE-627 | ||
| 005 | 20240217232416.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240216s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1177/20499361241231482 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1297.xml |
| 035 | |a (DE-627)NLM368519996 | ||
| 035 | |a (NLM)38361916 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Giacinta, Alessandro |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Aspergillus granulosus femoral osteomyelitis in a cardiac transplant patient |b first reported case and literature review |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 17.02.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © The Author(s), 2024. | ||
| 520 | |a Aspergillus osteomyelitis is a rare complication of extrapulmonary invasive aspergillosis, which usually presents as spondylodiscitis. The clinical picture is usually paucisymptomatic and of long evolution, which leads to diagnostic difficulties, especially in immunosuppressed patients presenting a delayed systemic host response. We report a case of femoral osteomyelitis caused by Aspergillus granulosus in a heart transplant recipient successfully treated with a combined surgical and antifungal approach. A 65-year-old heart transplant male presented with left knee pain lasting 3 months. X-ray and magnetic resonance imaging identified a lesion with aggressive characteristics at the distal third of the left femur, due to which the patient underwent excisional surgery. Aspergillus granulosus was cultured from the removed material and antifungal treatment with oral isavuconazole was started. Chest imaging excluded pulmonary aspergillosis, while the positron emission tomography/computed tomography (PET/CT) identified a remnant of a prosthetic vascular graft sewn to the proximal third of the right axillary artery, through which a catheter-based micro-axial left ventricular assist device was implanted previously as bridge to transplant therapy. The patient presented a rapid clinical improvement with complete functional recovery following the surgical treatment and the antifungal therapy and finally underwent surgical removal of the residual vascular graft. This is the first reported episode of long bone osteomyelitis due to A. granulosus that occurred in a heart transplant recipient without pulmonary infection and was successfully treated with isavuconazole. The PET/CT was useful in supporting the diagnostic process and follow-up. Cryptic fungal species can cause invasive infections, particularly in immunocompromised patients. Molecular methods are crucial in fungal identification | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a Aspergillus granulosus | |
| 650 | 4 | |a case report | |
| 650 | 4 | |a heart transplantation | |
| 650 | 4 | |a invasive aspergillosis | |
| 650 | 4 | |a invasive fungal infection | |
| 650 | 4 | |a osteomyelitis | |
| 650 | 4 | |a solid organ transplantation | |
| 700 | 1 | |a Blázquez, Zorba |e verfasserin |4 aut | |
| 700 | 1 | |a García Clemente, Paloma |e verfasserin |4 aut | |
| 700 | 1 | |a Pedraz, Álvaro |e verfasserin |4 aut | |
| 700 | 1 | |a Escribano, Pilar |e verfasserin |4 aut | |
| 700 | 1 | |a Guinea, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Valerio, Maricela |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Therapeutic advances in infectious disease |d 2013 |g 11(2024) vom: 19. Jan., Seite 20499361241231482 |w (DE-627)NLM239371976 |x 2049-9361 |7 nnns |
| 773 | 1 | 8 | |g volume:11 |g year:2024 |g day:19 |g month:01 |g pages:20499361241231482 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1177/20499361241231482 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 11 |j 2024 |b 19 |c 01 |h 20499361241231482 | ||