SUCCESSFUL TREATMENT OF ASPERGILLUS-INFECTED MALIGNANT PLEURAL EFFUSION

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Fungal pleural infections are difficult to treat especially when lung is trapped secondary to malignancy. CASE PRESENTATION: 65-year-old male underwent unsuccessful talc pleurodesis for malignant effusion. The patient presented 6 weeks later with severe cough, fatigue, and mild neutropenia. Recurrent effusion was noted and brown fluid aspirated with immediate relief and patient was started on antimicrobials. Cultures grew Streptococcus mitis and Aspergillus species. Patient was admitted and treated with IV antibiotics and PO voriconazole. One week later, he underwent exploration: lung was partly trapped; surfaces were covered by white debris, which was scraped off and pleural space washed out with water and filled with Amphotericin B solution (100mg/1L). After 30 minutes, a tunneled pleural catheter (TPC) was placed. TPC was drained 48h later and continued with every-other-day drainage. Amoxicillin/clavulanate + voriconazole PO continued for 5 weeks. Every other week pleural fluid cultures were obtained and were negative. TPC stopped draining 3 months later and was removed. Currently, the patient has no evidence of malignancy recurrence by PET. Imaging demonstrates trapped lung. DISCUSSION: In this situation, intraoperative washout and intrapleural Amphotericin B instillation were done to help sterilize pleural space in the setting of trapped lung. TPC allowed frequent drainage of pleural space as the infection can be managed successfully in 72% of patients without TPC removal. As prolonged drainage was anticipated, TPC was thought to be more comfortable than a larger bore chest tube/collection system. CONCLUSIONS: Intrapleural antifungal therapy can effectively sterilize pleural space and TPC can be used when repeat administration is anticipated. DISCLOSURE: Nothing to declare. KEYWORD: Aspergillus, tunneled pleural catheter