Prostatic Aspergillosis in a Heart Transplant Recipient: Case Report and Review

doi:10.1016/j.healun.2009.03.002

The Journal of Heart and Lung Transplantation

Volume 28, Issue 6, June 2009, Pages 638-646

https://doi.org/10.1016/j.healun.2009.03.002 Get rights and content

In this study we report the first case of invasive prostatic aspergillosis (IPRA) in a heart recipient with post-transplantation antibody deficiency, and review the other 11 cases described in the medical literature. Seven patients were immunocompromised and 6 had dissemination to other sites. Examination of the prostate usually revealed enlargement, with or without nodular lesions. Transrectal ultrasonography or computed tomography scan can provide the diagnosis, although this should be confirmed with biopsy and culture of the lesion. Urine culture can be negative and treatment should include long-term systemic anti-fungal therapy and, in most cases, prostatectomy.

Section snippets

Case Report

A 65-year-old man who had undergone heart transplantation (HT) was admitted because of persistent dysuria and low-grade fever. Initially, he required HT because of terminal coronary disease and ventricular dysfunction, which occurred 9 months prior to onset of the current symptoms. He received daclizumab (2 doses of 75 mg) and methylprednisolone (500 mg pre-operatively as induction therapy, 3 doses of 125 mg, with tapering from 60 mg/day to 10 mg/day for 7 months, and then 5 mg/day) and was on

Literature Review

We searched MEDLINE for articles in English, French or Spanish published since 1966 using the medical subject headings (MeSH) “Prostate,” “Prostatic,” “Aspergillosis” and “Aspergillus.” We searched reference lists to identify additional reports of prostatic aspergillosis. After a thorough search of the literature, we were able to identify 12 cases of IPRA (including the case reported by our group in this study). The most important characteristics of these patients are presented in Table 2 and a

Discussion

We have reported the first case of a heart recipient with IPRA and reviewed the few earlier reports of this condition.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 The small number of previous reports could mean that the disease is either underestimated or underreported.

It is clear that IPRA affects not only immunosuppressed patients, but that it may also affect patients with different underlying systemic conditions or appearing in the absence of traditional predisposing factors for invasive aspergillosis.

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Cited by (6)

Selection of Aspergillus fumigatus isolates carrying the G448S substitution in CYP51A gene after long-term treatment with voriconazole in an immunocompromised patient
2022, Medical Mycology Case Reports
Citation Excerpt :
Invasive prostatic aspergillosis (IPRA) is a rare condition with a few cases in the literature. Moreover, the prostate is considered a reservoir of microorganisms, where higher doses of VRC are recommended for treatment [15,16]. Table 1 shows increasing MICs for VRC according to the isolates date.
We present a case of a 55-year-old man with a heart transplant who acquired Invasive Aspergillosis by Aspergillus fumigatus with the focus in the kidney. During about two years of antifungal treatment, most of the time with voriconazole, it was possible to obtain nine isolates of A. fumigatus, with the same genotypic characteristics, but with an increase in MIC for several azoles. The two last isolates presented high MICs for Voriconazole (>8 μg/mL>). Sequencing of the CYP51A gene showed G448S amino acid substitution in the same two isolates. In long-term treatments with antifungals, it would be important to regularly evaluate the susceptibility of isolated strains, as resistance to azoles has been increasingly described around the world.
Invasive aspergillosis among heart transplant recipients: A 24-year perspective
2014, Journal of Heart and Lung Transplantation
Citation Excerpt :
Since we began to prescribe targeted prophylaxis with echinocandins or voriconazole in the at-risk population, we had only 6 cases of IA, all but 1 related, in one way or another, to breaks in our protocol. One patient had very late prostatic aspergillosis, with no indication for prophylaxis, which resolved with anti-fungal therapy.22 Another case involved underdosing of prophylactic caspofungin in a patient with liver insufficiency, who developed pulmonary aspergillosis on Day 16 after transplantation and died with bacterial ventilator-associated pneumonia.
Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem.
We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution.
Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09).
In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.
Epidemiology and risk factors of infections after solid organ transplantation
2012, Enfermedades Infecciosas y Microbiologia Clinica
Infection remains a significant complication after solid organ transplantation (SOT). The incidence of various pathogens varies widely depending on the presence of specific factors, according to which patients can be classified into different risk categories that may merit tailored prophylaxis strategies. Both the endogenous origin of microorganisms (previous colonization or latent infection) and new acquisition (primary infection from donor or environment) should be considered. Bacterial infections predominate in patients with complex hospital stays or anatomical alterations. Viral infections, caused both by opportunistic (CMV, EBV, BKV, etc.) and common viruses (influenza, respiratory virus, VVZ, etc.), are of great importance, and may contribute to chronic rejection. Fungal infections are uncommon nowadays, but cause high mortality and deserve prophylaxis for a subset of patients. Parasitic infections are a clear threat, mainly in transplanted patients or those travelling to endemic areas. Physicians attending SOT recipients should be aware of these risk factors, which include specific host characteristics, type of transplantation, microorganism and immunosuppressive policy.
La infección sigue siendo una complicación significativa tras el trasplante de órgano sólido (TOS). La incidencia de los diferentes patógenos varía ampliamente dependiendo de la presencia de factores específicos y, de acuerdo con esto, los pacientes pueden clasificarse en diferentes categorías de riesgo que precisarán estrategias profilácticas específicas para cada categoría. Deben tenerse en cuenta tanto los microorganismos de origen endógeno (colonización previa o infección latente) como los de nueva adquisición (infección primaria a partir del donante o del entorno). Las infecciones bacterianas predominan en los pacientes con estancias hospitalarias complejas o alteraciones anatómicas. Las infecciones virales, causadas tanto por virus oportunistas (citomegalovirus, virus de Epstein-Barr, virus BK, etc.) como por virus comunes (influenza, virus respiratorios, virus de la varicela zoster, etc.) son esenciales y pueden contribuir al rechazo crónico del trasplante. Las infecciones fúngicas no son habituales hoy en día, pero provocan una alta mortalidad y precisan profilaxis en un subgrupo de pacientes. Las infecciones parasitarias son una clara amenaza, principalmente en pacientes trasplantados que viajen a zonas endémicas. Los médicos que tratan a los receptores de TOS deben ser conscientes de estos factores de riesgo, que incluyen las características específicas del receptor, tipo de trasplante, microorganismo y planes de inmunosupresión.
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2022, Revista Espanola de Quimioterapia
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2019, OBM Transplantation
Fungal prostatitis: An update
2014, Analytical and Quantitative Cytology and Histology

: Supported by a research fellowship from Fundación BBVA-Fundación Carolina (to M.V.). The immunologic studies were funded by Project FIS 05/0839.

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Case reportProstatic Aspergillosis in a Heart Transplant Recipient: Case Report and Review

Section snippets

Case Report

Literature Review

Discussion

Urology

J Urol

Urology

J Heart Lung Transplant

Int Immunopharmacol

Transplant Proc

J Heart Lung Transplant

Aspergillus flavus in prostatic fluid

Br J Urol

Aspergillosis of the prostate associated with an indwelling bladder catheter: case report and review

Clin Infect Dis

Aspergillus prostatitis and prolonged corticotherapyApropos of a case report

Acta Urol Belg

Prostatitis and epididymo-orchitis due to Aspergillus fumigatus in a patient with AIDS

Clin Infect Dis

Prostatic abscess due to Aspergillus fumigatus: TRUS and MR imaging findings

J Ultrasound Med

Prostatic aspergillosis in a renal transplant recipient

Nephrol Dial Transplant

Concomitant renal and prostatic aspergillosis

Int Urol Nephrol

Mycotic abdominal aortic aneurysm: a fatal sequel to concomitant prostatic and renal aspergillosisCase report and review of the literature

Urol Int

Systemic aspergillosis with predominant genitourinary manifestations in an immunocompetent man: what we can learn from a disastrous follow-up

Infection

Case report
Prostatic Aspergillosis in a Heart Transplant Recipient: Case Report and Review