Tuberc Respir Dis.  2014 Nov;77(5):223-226. 10.4046/trd.2014.77.5.223.

Aspergillus Tracheobronchitis in a Mild Immunocompromised Host

• Cho BH
• Oh Y
• Kang ES
• Hong YJ
• Jeong HW
• Lee OJ
• Chang YJ
• Choe KH
• Lee KM
• An JY

• KMID: 2050716
• DOI: http://doi.org/10.4046/trd.2014.77.5.223

Abstract

Aspergillus tracheobronchitis is a form of invasive pulmonary aspergillosis in which the Aspergillus infection is limited predominantly to the tracheobronchial tree. It occurs primarily in severely immunocompromised patients such as lung transplant recipients. Here, we report a case of Aspergillus tracheobronchitis in a 42-year-old man with diabetes mellitus, who presented with intractable cough, lack of expectoration of sputum, and chest discomfort. The patient did not respond to conventional treatment with antibiotics and antitussive agents, and he underwent bronchoscopy that showed multiple, discrete, gelatinous whitish plaques mainly involving the trachea and the left bronchus. On the basis of the bronchoscopic and microbiologic findings, we made the diagnosis of Aspergillus tracheobronchitis and initiated antifungal therapy. He showed gradual improvement in his symptoms and continued taking oral itraconazole for 6 months. Physicians should consider Aspergillus tracheobronchitis as a probable diagnosis in immunocompromised patients presenting with atypical respiratory symptoms and should try to establish a prompt diagnosis.

Keyword

Aspergillosis, Allergic Bronchopulmonary; Itraconazole; ronchoscopy

MeSH Terms

Adult
Anti-Bacterial Agents
Antitussive Agents
Aspergillosis, Allergic Bronchopulmonary
Aspergillus*
Bronchi
Bronchoscopy
Cough
Diabetes Mellitus
Diagnosis
Gelatin
Humans
Immunocompromised Host*
Invasive Pulmonary Aspergillosis
Itraconazole
Lung
Sputum
Thorax
Trachea
Transplantation
Anti-Bacterial Agents
Antitussive Agents
Gelatin
Itraconazole

Figure

• 

  Figure 1 (A) Chest radiograph obtained 1 year ago showing a destroyed tuberculosis scar in the left lung and right middle and lower lung fields. (B) Chest radiograph obtained upon admission does not show any significant changes from the radiograph obtained in the previous year. (C) Chest computed tomography image showing a fibrotic cavity, traction bronchiectasis, and multiple small nodules with destructive changes in both lungs.

• 

  Figure 2 (A-C) Bronchoscopic examination images obtained upon admission showing multiple, discrete, gelatinous, whitish plaques mainly involving the trachea and the left bronchus. (D-F) Follow-up bronchoscopic examination images showing significant improvement compared to numerous gelatinous whitish plaques in the trachea and the left bronchus that were seen earlier.

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