RapidOnsetPul

monar
yAsper
gil
l
osi
sinCKDPat
ient
sWhoUnder
wentaKi
dney
Transpl
ant
ati
onwit
hNODAT
Lusi
to

Abst
ract
Backgr
ound
Asper
gill
osisisaseriousinfecti
oninpati
entsundergoingki dneytr
ansplantsespecial
l
y
i
fther
ei saspread.Patientsundergoi
ngkidneytransplantssuf f
eri
ngfr
om NODAThav e
beenreport
edt oincr
easet heinci
denceofinfect
ions,cardiovascul
ardisease,graf
t
rej
ect
ion,acceler
atedgraftlossandreducedpati
entssur vival.
Case
ACKDpat ientwhohadunder goneaki dneytransplantsthreemont hagowi th
compl aintsoff ever,pr
oduct ivecough, al
umponhi shandandal umponhi sback.
Phy si
cal examinat i
onwasf ound: dull
nessintherightlung, r
oughwetr honchi i
nt he
ri
ghtlungwi thbronchialbasesoundsandmul t
ipl
esubcut aneoust umorwi t
ht hel argest
diamet erof2cm.Labor atoryexami nationfoundani ncreaseinbloodsugarl evelsand
HbA1C, thechestx- rayradiographsf oundhomogeneousopaci t
yintherightlung,
thoracicMSCTf oundpneumoni aaccompani edbycav i
tyandmul t
ipl
enodule.Sof t
Tissueul tr
asoundf oundmul t
ipl
esol i
dmasses.Hi stopathologyofbronchialveolarf l
uid
wasf oundt obechr onicinflammat ioncausedbyf ungal i
nfecti
onsandgr anulomat ous
reacti
onscausedbyasper gill
usfrom subcutaneoust umorbi opsy.Pati
entstreatedwi t
h
vari
conazol eandor alhypogl y
cemi adrugs.
Di
scussi
on
Theuseofi mmunosuppr essioninpatientsunderwentkidneytr
ansplantsincreasesthe
i
ncidenceoff ungal infectionsandNODAT.I nv asi
veaspergi
ll
osispneumoni ais
establi
shedbyf indingf ungi i
nbr onchi
alveol
arl i
qui
dandf i
ndingaspergi
llusfungiin
subcutaneoust umorbi opsyasaf orm ofspreadingaspergi
ll
usfrom thelungs.NODAT
i
sest abli
shedbyi ncr easingbl oodsugarlevelsandHbA1C.Thi sstudyprov esthatthe
useofv ari
conazol eandor alhy pogl
ycemiadr ugshaveimprovedthepat i
ent’sconditi
on.