After the 20th day, the patient underwent orthotopic
heart transplant. The explanted heart’s pathological examination
revealed dilated cardiomyopathy without a specific etiology, leading to
the diagnosis of idiopathic dilated cardiomyopathy (Figure 4).
Following the successful transplant, the overall clinical condition
showed improvement, enabling the removal of all mechanical circulatory
support and the discontinuation of antibiotics within 7 days.
Voriconazole was continued to treat probable IPA, in addition to
immunosuppressive drugs such as tacrolimus, mycophenolic acid, and
prednisolone.