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Management of postpneumonectomy Aspergillus empyema extending into the thoracic wall: a plea for radical surgery and caution when using liposomal amphotericin B

^a Centre Valaisan de Pneumologie, 3962 Montana, Switzerland
^b Département de Chirurgie Thoracique, HUG, 1211 Geneva 4, Switzerland
^c Département d'Anesthésiologie, HUG, 1211 Geneva 4, Switzerland

^* Corresponding author
jean-marie.tschopp{at}admin.vs.ch

Semi-invasive aspergillosis is a rare disease leading to severe complications even in fully immunocompetent patients. The therapeutic role of systemic and intrapleural antifungal agents remains not well known. We report herein the case of a 54-year-old woman who developed Aspergillus empyema invading the thoracic wall and subcutaneous tissues after completion pneumonectomy for aspergilloma. She initially was treated conservatively with systemic and intrapleural amphotericin B without any success and developed a severe anaphylactic reaction to intravenous liposomal amphotericin B (Ambisome®). She then underwent an open-window thoracotomy with intrathoracic transposition of a latissimus dorsi muscle flap and was started on itraconazole therapy. The thoracostomy was closed after 6 months and the patient is doing well without any signs of recurrent infection after 3 years.

Key Words: Semi-invasive aspergillosis; Liposomal amphotericin B; Anaphylactic shock; Surgery