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Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report

BACKGROUND. Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematologic malignancies. Acquired gastropulmonary fistula is a rare complication of IFI. MATERIAL AND METHODS. We present a case history of a pati...

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Autores principales: Janilionis, Ričardas, Lukoševičiūtė, Lina, Beiša, Virgilijus, Jotautas, Valdemaras, Petrauskaitė, Roberta, Pečeliūnas, Valdas, Jucaitienė, Renata
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lithuanian Academy of Sciences Publishers 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287989/
https://www.ncbi.nlm.nih.gov/pubmed/28356805
http://dx.doi.org/10.6001/actamedica.v23i3.3381
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author Janilionis, Ričardas
Lukoševičiūtė, Lina
Beiša, Virgilijus
Jotautas, Valdemaras
Petrauskaitė, Roberta
Pečeliūnas, Valdas
Jucaitienė, Renata
author_facet Janilionis, Ričardas
Lukoševičiūtė, Lina
Beiša, Virgilijus
Jotautas, Valdemaras
Petrauskaitė, Roberta
Pečeliūnas, Valdas
Jucaitienė, Renata
author_sort Janilionis, Ričardas
collection PubMed
description BACKGROUND. Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematologic malignancies. Acquired gastropulmonary fistula is a rare complication of IFI. MATERIAL AND METHODS. We present a case history of a patient with malignant myeloma. She was treated with autologous stem cell transplantation and chemotherapy for three years. She had been treated with antifungal agents as well. Following a specific treatment, she developed an invasive fungal infection (IFI) of the left lung which had been complicated with left gastropulmonary fistula. The patient’s general condition was deteriorating, so it was decided to perform a surgical intervention. At the first procedure, open-window thoracostomy was created in order to facilitate treatment by daily packing of the cavity. Four weeks after the thoracostomy, a thoracomyoplasty was performed to repair a gastropleural fistula. During the laparotomy, the gastric fundus was freed from adjacent tissues and repaired. Intrathoracic transposition of the latissimus dorsi and anterior serratus muscle flaps was performed simultaneously to create a new diaphragm. The open-window thoracostomy was left open due to some small bronchial fistulas. The thoracostomy opening healed spontaneously during the following six months. CONCLUSION. We report what is, to the best of our knowledge, the first case of an invasive fungal infection (Geotrichum capitatum) successfully treated with intravenous amphotericin B, voriconazole, and surgery on infected soft tissues (organs) for a patient with multiple myeloma in prolonged neutropenia. The efficacy and safety of the surgery for infected soft tissues requires further evaluation.
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spelling pubmed-52879892017-03-29 Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report Janilionis, Ričardas Lukoševičiūtė, Lina Beiša, Virgilijus Jotautas, Valdemaras Petrauskaitė, Roberta Pečeliūnas, Valdas Jucaitienė, Renata Acta Med Litu Research Article BACKGROUND. Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematologic malignancies. Acquired gastropulmonary fistula is a rare complication of IFI. MATERIAL AND METHODS. We present a case history of a patient with malignant myeloma. She was treated with autologous stem cell transplantation and chemotherapy for three years. She had been treated with antifungal agents as well. Following a specific treatment, she developed an invasive fungal infection (IFI) of the left lung which had been complicated with left gastropulmonary fistula. The patient’s general condition was deteriorating, so it was decided to perform a surgical intervention. At the first procedure, open-window thoracostomy was created in order to facilitate treatment by daily packing of the cavity. Four weeks after the thoracostomy, a thoracomyoplasty was performed to repair a gastropleural fistula. During the laparotomy, the gastric fundus was freed from adjacent tissues and repaired. Intrathoracic transposition of the latissimus dorsi and anterior serratus muscle flaps was performed simultaneously to create a new diaphragm. The open-window thoracostomy was left open due to some small bronchial fistulas. The thoracostomy opening healed spontaneously during the following six months. CONCLUSION. We report what is, to the best of our knowledge, the first case of an invasive fungal infection (Geotrichum capitatum) successfully treated with intravenous amphotericin B, voriconazole, and surgery on infected soft tissues (organs) for a patient with multiple myeloma in prolonged neutropenia. The efficacy and safety of the surgery for infected soft tissues requires further evaluation. Lithuanian Academy of Sciences Publishers 2016 /pmc/articles/PMC5287989/ /pubmed/28356805 http://dx.doi.org/10.6001/actamedica.v23i3.3381 Text en © Lietuvos mokslų akademija, 2016
spellingShingle Research Article
Janilionis, Ričardas
Lukoševičiūtė, Lina
Beiša, Virgilijus
Jotautas, Valdemaras
Petrauskaitė, Roberta
Pečeliūnas, Valdas
Jucaitienė, Renata
Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report
title Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report
title_full Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report
title_fullStr Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report
title_full_unstemmed Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report
title_short Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report
title_sort successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287989/
https://www.ncbi.nlm.nih.gov/pubmed/28356805
http://dx.doi.org/10.6001/actamedica.v23i3.3381
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