Recent Advances in TransplantationCase reportInvasive Tracheobronchial Aspergillosis in a Lung Transplant Recipient Receiving Belatacept as Salvage Maintenance Immunosuppression: A Case Report

•Invasive tracheobronchial aspergillosis is an unusual finding in the late post lung transplant course.•Belatacept may increase the risk of severe and unusual opportunistic infections among lung transplant recipients by inhibiting protective cytokines.•Belatacept should be used with caution and as a measure of last resort in lung transplant recipients.

IntroductionThe association between belatacept, a CD28 costimulation blocker, and invasive mycoses is unclear.Case ReportWe describe a patient who initiated belatacept 3 years after lung transplantation and developed invasive tracheobronchial aspergillosis, a disease encountered almost exclusively within the first 6 months after transplantation.ConclusionsBelatacept may have played a causative role. Until more data are available, belatacept should be used cautiously after lung transplantation.