{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T21:58:20Z","timestamp":1776722300366,"version":"3.51.2"},"reference-count":33,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Hematopoietic stem cell transplant (HSCT) recipients are at high risk for opportunistic infections due to profound immunosuppression and graft-versus-host disease (GvHD). Molds and nontuberculous mycobacteria (NTM) pose diagnostic and therapeutic challenges, especially when infections overlap. A 42-year-old woman with prior allogeneic HSCT for acute myeloid leukemia (AML) developed pulmonary infections with Microascus spp. and Mycobacterium chimaera, later complicated by Aspergillus calidoustus and RSV infection. Initial therapy included voriconazole, amphotericin B, and a macrolide-based multidrug regimen for NTM. Modifications were required for drug resistance and hepatotoxicity. Despite partial response, recurrent fungal infection necessitated prolonged antifungal therapy, including adjunctive inhaled amphotericin B and terbinafine. Ultimately, progressive bronchiolitis obliterans prompted bilateral lung transplantation. Explant pathology revealed necrotizing granulomas positive for NTM and Microascus spp. Post-transplant prophylaxis with voriconazole, rifabutin, azithromycin, and inhaled amikacin prevented recurrence, and the patient remained clinically stable at 6-month follow-up. This case illustrates the complexity of managing overlapping mold and NTM infections in HSCT recipients, highlighting the need for individualized, multidisciplinary care. Therapeutic drug monitoring, careful adjustment for drug\u2013drug interactions, and the use of adjunctive inhaled antifungals were critical to achieving a favorable outcome.<\/jats:p>","DOI":"10.3390\/curroncol33030145","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T08:51:57Z","timestamp":1772441517000},"page":"145","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Concurrent Mold, Mycobacterial, and Viral Infections in a Hematopoietic Stem Cell Transplant Recipient Undergoing Lung Transplantation for Graft-Versus-Host Disease"],"prefix":"10.3390","volume":"33","author":[{"given":"Layan","family":"Akkielah","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Western University, London Health Sciences Centre, London, ON N6A 4V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Western University, London Health Sciences Centre, London, ON N6A 4V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Western University, London Health Sciences Centre, London, ON N6A 4V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0846-3534","authenticated-orcid":false,"given":"Lili","family":"Ataie","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Western University, London Health Sciences Centre, London, ON N6A 4V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anargyros","family":"Xenocostas","sequence":"additional","affiliation":[{"name":"Division of Hematology, Department of Medicine, Western University, London Health Sciences\u2014Victoria Hospital, London, ON N6A 4V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asma","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Transplant Infectious Diseases, Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4531-820X","authenticated-orcid":false,"given":"Ying-Han R.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Program, University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Silverman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Western University, London Health Sciences Centre, London, ON N6A 4V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3978-1823","authenticated-orcid":false,"given":"Fatimah","family":"AlMutawa","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 4V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2410-6788","authenticated-orcid":false,"given":"MohammadReza","family":"Rahimi Shahmirzadi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Western University, London Health Sciences Centre, London, ON N6A 4V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.bbmt.2009.06.019","article-title":"Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective","volume":"15","author":"Tomblyn","year":"2009","journal-title":"Biol. 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