Pulmonary aspergillosis caused by Neosartorya fischeri (Aspergillus fischerianus) in a liver transplant recipient

Introduction: Laboratory diagnosis of aspergillosis may be difficult without confirmatory clinical and microscopic evidence. We report a case of pulmonary aspergillosis caused by Neosartorya Fischeri in a liver transplant recipient. Clinical case: The patient was a 42-year-old white man with HCV Ab positive cirrhosis of the liver diagnosed in 1983. In January 1996 he was submitted to an orthotopic liver transplantation from a cadaveric donor. In the 6th post operative day a primary graft non-function was suspected and the patient was retransplanted. On the 2th post operative day a fungus was detected both by microscopic and cultural examination, on samples obtained from bronchial washing. Result: Microscopic examination of the bronchial washing revealed the presence of a large amount of septate hyphae showing frequently terminal or intercalary globose bodies. At room temperature on Sabouraud's agar, whitish fast-growing colonies developed. The isolate produced only scant amounts of conidiophores and uniseriate heads resembling those of Aspergillus fumigatus. Within three weeks ascomata, asci and ascospores developed and the fungus was identified as Neosartorya fischeri tan. Aspergillus fischerianus). Conclusion: We think that globose bodies of septate hyphae, for their size and because present in large amounts, are ascospores rather than conidia. Neosartorya fischeri has seldom been reported in human infection. In our case the pathogenic role of this sexual state of Aspergillus has been clarified on the grounds of the correlation between positive cultures and microscopic findings.