Fibrillar – a novel antifungal delivery method: most unusual case of Aspergillus fumigatus empyema and bronchopleural fistulae after right-sided pneumonectomy, treated successfully by innovative salvage therapy

Ref ID: 17697

Author:

A. Guleri, A. Duncan, M. Hassan, T. Al-Badawi*,
M. Purohit

Author address:

Blackpool, UK)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Background: We present a most unusual and challenging case of
Aspergillus fumigatus[AF] empyema and bronchopleural fistulae after
right sided pneumonectomy. The topography and expanse of fungal
growth within the chest cavity made drug delivery and sustained
exposure to antifungal agent a challenge. Literature search/consultation
with experts was of limited benefit. An innovative and novel antifungal
delivery method was planned as a salvage to treat the infection.
Case Study: A 52-year old gentleman, heavy smoker for 35 years, was
hospitalised with chest symptoms and diagnosed with right upper lobe
mass. He underwent an elective pneumonectomy. Histology showed
well differentiated squamous cell carcinoma, T3N1M0. His
postoperative period was complicated by development of a
bronchopleural fistula. An Elossier flap (open stoma) was created to
drain the space. This followed long term follow up review in outpatient
clinic. In February 2010, review in clinic revealed the presence of thick
layer of deposit with a green sheen visible through Elossier flap on the
inner wall of chest cavity. Tissue samples for culture isolated pure
growth of Aspergillus fumigatus. Systemic treatment with voriconazole
did not clear the fungus.
Salvage therapy was planned, discussed with patient and consent
obtained. Access to inside of chest cavity through Elossier flap,
debridement of thick layer of deposit and amphotericin powder
insufflation to cover pleural surface. This was packed with Fibrillar
[haemostat] to allow sustained exposure to amphotericin. The patient
had four such procedures and systemic posaconazole 400 mg q12h po
was continued postoperatively. He made slow but good progress and
increased some weight by April 2010. He was kept on long term
posaconazole and follow up review in clinic. Culture of swabs were
negative for fungus. Video of the procedure is available

Abstract Number: P864

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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