Tuberc Respir Dis.  2008 Nov;65(5):400-404.

Pseudomembranous Aspergillus Tracheobronchitis in an Immunocompetent Patient

• Cha SI
• Shin KM
• Yoo SS
• Jeong JY
• Yoon GS
• Lee SY
• Kim CH
• Park JY
• Jung TH

Abstract

Aspergillus tracheobronchitis (ATB), a variant of invasive pulmonary aspergillosis, is characterized by extensive tracheobronchitis and pseudomembrane formation. ATB usually occurs in immunocompromised patients with a high fatality rate. We report a case of ATB in a previously healthy patient who responded well to antifungal therapy.

Keyword

Aspergillus; Bronchitis; Immunocompetence

MeSH Terms

Aspergillus
Bronchitis
Humans
Immunocompetence
Immunocompromised Host
Invasive Pulmonary Aspergillosis

Figure

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  Figure 1 (A) Initial chest radiograph reveals peribronchial infiltrates in both lungs. (B) On the 4th day, the peribronchial infiltrates in the right middle lobe coalesce to a diffuse consolidation (arrow). (C) One month after discontinuing antifungal therapy, chest radiograph shows healed lesions in both lungs.

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  Figure 2 On CT scan, peribronchial consolidation (arrow) with bronchial wall thickening (arrowheads) in the right upper lobe and right middle lobe is noted.

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  Figure 3 Initial bronchoscopic examination reveals extensive tracheobronchitis and white-to-yellowish thick pseudomembrane throughout the trachea (A, B) and right middle lobe (C). Repeat bronchoscopy shows a remarkable improvement of previous lesions in the trachea (D, E) and right middle lobe (F).

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  Figure 4 Bronchoscopic biopsy demonstrated septate hyphae with branching at 45° (A: H&E stain, ×400; B: methenamine silver stain, ×400).

Reference

1. Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002. 121:1988–1999.

2. Sharma OP, Chwogule R. Many faces of pulmonary aspergillosis. Eur Respir J. 1998. 12:705–715.

3. Routsi C, Platsouka E, Prekates A, Rontogianni D, Paniara O, Roussos C. Aspergillus bronchitis causing atelectasis and acute respiratory failure in an immunocompromised patient. Infection. 2001. 29:243–244.

4. Routsi C, Kaltsas P, Bessis E, Rontogianni D, Kollias S, Roussos C. Airway obstruction and acute respiratory failure due to Aspergillus tracheobronchitis. Crit Care Med. 2004. 32:580–582.

5. Tasci S, Glasmacher A, Lentini S, Tschubel K, Ewig S, Molitor E, et al. Pseudomembranous and obstructive Aspergillus tracheobronchitis - optimal diagnostic strategy and outcome. Mycoses. 2006. 49:37–42.

6. Machida U, Kami M, Kanda Y, Takeuchi K, Akahane M, Yamaguchi I, et al. Aspergillus tracheobronchitis after allogeneic bone marrow transplantation. Bone Marrow Transplant. 1999. 24:1145–1149.

7. van Assen S, Bootsma GP, Verweij PE, Donnelly JP, Raemakers JM. Aspergillus tracheobronchitis after allogeneic bone marrow transplantation. Bone Marrow Transplant. 2000. 26:1131–1132.

8. Boots RJ, Paterson DL, Allworth AM, Faoagali JL. Successful treatment of post-influenza pseudomembranous necrotising bronchial aspergillosis with liposomal amphotericin, inhaled amphotericin B, gamma interferon and GM-CSF. Thorax. 1999. 54:1047–1049.

9. Franco J, Munoz C, Vila B, Marin J. Pseudomembranous invasive tracheobronchial aspergillosis. Thorax. 2004. 59:452.

10. Nicholson AG, Sim KM, Keogh BF, Corrin B. Pseudomembranous necrotising bronchial aspergillosis complicating chronic airways limitation. Thorax. 1995. 50:807–808.

11. Chang SM, Kuo HT, Lin FJ, Tzen CY, Sheu CY. Pseudomembranous tracheobronchitis caused by Aspergillus in immunocompromised patients. Scand J Infect Dis. 2005. 37:937–942.

12. Denning DW. Commentary: unusual manifestations of aspergillosis. Thorax. 1995. 50:812–813.

13. Bulpa PA, Dive AM, Garrino MG, Delos MA, Gonzalez MR, Evrard PA, et al. Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care? Intensive Care Med. 2001. 27:59–67.