Case Series on Post Renal Transplant Fungal Infections of the Lung

Invasive fungal infections are a significant concern for solid organ transplant (SOT) patients, especially those who have undergone small bowel or lung transplants. Renal transplant recipients commonly develop fungal infections like candidiasis, aspergillosis, and cryptococcosis, contributing to post-transplant infections. This case series presents three cases of pulmonary fungal infections after renal transplantation: cryptococcosis, mucormycosis, and invasive pulmonary aspergillosis. The objective is to highlight challenges in diagnosing and managing invasive fungal infections in SOT recipients, emphasizing early diagnosis, timely treatment initiation, and optimized antifungal drug pharmacokinetics for successful outcomes.

Aims and Objectives: Include emphasizing the importance of prompt diagnosis and treatment, optimizing antifungal drug pharmacokinetics, and highlighting the need for intensive antifungal therapy in SOT patients with fungal infections.

Methods: The cases involve comprehensive clinical information, diagnostic procedures (imaging, endoscopy, biopsies, microscopy, culture, and serologic testing), and treatment approaches. Antifungal therapy was promptly initiated, even without laboratory confirmation, to ensure timely treatment. Antifungal drug pharmacokinetics were optimized to minimize nephrotoxicity in SOT patients.

Results: Case 1 describes a middle-aged obese woman with respiratory symptoms diagnosed with cryptococcosis. Case 2 presents a young male kidney transplant recipient with mucormycosis. Case 3 involves a male patient with cough and hemoptysis diagnosed with invasive pulmonary aspergillosis. All cases received appropriate antifungal therapy, leading to symptom resolution and radiological improvement, although some patients had persistent radiological opacities.

Discussion: Diagnosing invasive fungal infections in transplant patients remains challenging, relying on clinical presentation and supportive diagnostic procedures. Management requires a multidisciplinary approach involving antifungal therapy, surgical intervention (if applicable), and control of predisposing factors. Primary treatments included liposomal amphotericin B and voriconazole, considering combination therapy and newer antifungal agents. Early detection and prompt treatment initiation are crucial to reduce mortality rates, especially in disseminated disease.

Conclusion: Invasive fungal infections present significant challenges in solid organ transplant recipients. Despite advancements in diagnostics and antifungal therapies, mortality and graft loss rates remain high, particularly in disseminated disease cases. Future research should integrate data from various sources to enhance understanding of fungal pathogenesis, host immune responses, and pharmacological aspects, aiming to develop more effective prevention and treatment strategies for fungal infections in transplant recipients.