1. A case of invasive aspergillosis in a lung transplant patient Dr. Dino Sgarabotto Transplant ID Unit Padova General Hospital Italy

4. The patient suffered from fever and urine retention. Treated unsuccessfully with ciprofloxacin. Persistence of 39°C intermittent fever every 3 days: new hospitalization December 2010 Blood and urine culture: negative WBC: normal; anemia CRP: 128 mg/dL PSA: normal Creatinine: 132 mmol/L Chest X-Ray: negative

5. December 2010 Transrectal US: small prostatic abscess Cultures from post-prostatic massage fluid: Aspergillus spp . Abdomen US: 4.5 cm mass on the left upper kidney Chest CT scan, echocardiography and cerebral MRI : unremarkable.

6. Abdomen MRI

7. Abdomen MRI

9. PET-CT scan

10. The patient was restarted on voriconazole/caspofungin 3 weeks later fever unchanged, CRP 110 mg/dL and voriconazole trough level 3.2 ug/dL Patient treatment hystory Therapy was switched to Liposomal Amphotericin B 3mg/Kg/daily quick (1 day) disappearance of fever, CRP normalization, new culture of post-prostatic massage fluid: negative

11. Clinical case: March 2011… no fever, but… surgical enucleation

12. Cultures: Surgical enucleation Hystology: aspergilloma

13. Follow up: May-July 2011 US scan: no recrudescence No fever … but.. STOP LAmb 3 mg/kg/die LAmb 3 mg/kg/die

14. Lung transplant recipients are at high risk of invasive Aspergillosis. However, isolated urinary involvement of invasive aspergillosis is uncommon and its treatment is very controversial. Conclusions (1)