Images in Thorax

Pseudomembranous invasive tracheobronchial aspergillosis

J Franco, C Muñoz, B Vila, J Marín

Servicio de Neumología, Hospital Clínico Universitario, Valencia, Spain

Correspondence to:
Correspondence to:
Dr J Franco
Servicio de Neumología, Hospital Clínico Universitario, Avda Vicente Blasco Ibáñez 17, 46010 Valencia, Spain; jfs01v{at}nacom.es

Invasive aspergillus tracheobronchitis is a rare infectious complication in severely immunocompromised patients who are generally neutropenic with haematological diseases, AIDS, or after solid organ transplantation. However, a few cases have been reported with no apparent severe compromise in the host defences.¹ Aspergillus tracheobronchitis varies from localised tracheobronchitis discovered incidentally at necropsy to more or less extensive bronchial obstruction contributing to respiratory failure. The pseudomembranous form is the most severe condition and is usually fatal despite treatment with antifungal agents.² However, in non-severely immunocompromised patients the condition can be successfully treated, even in the presence of extensive tracheobronchial involvement.

A 70 year old man presented with a history of insulin dependent diabetes mellitus, chronic obstructive pulmonary disease, and old tuberculosis. The possible risk factors included broad spectrum antibiotics and corticosteroids. Fibreoptic bronchoscopy (fig 1A) revealed diffuse tracheobronchitis and wide raised cream-coloured plaques throughout the trachea, right mainstem, and upper lobe bronchi. One month after antifungal treatment (fig 1B) his condition showed significant improvement, with the white to yellow necrotic tissue being replaced by mucosal thickening. The patient is alive and well 1 year after the onset of his illness.

View larger version (62K): [in this window] [in a new window]   Figure 1 (A) Fibreoptic bronchoscopy revealed diffuse tracheobronchitis and wide raised cream-coloured plaques. (B) After 1 month of antifungal treatment there was significant improvement with the white to yellow necrotic tissue being replaced by mucosal thickening.

 

1. Nicholson AG, Sim KM, Keogh BF, et al. Pseudomembranous necrotising bronchial aspergillosis complicating chronic airways limitation. Thorax 1995;50:807–8.[Abstract/Free Full Text]
2. Hines DW, Haber MH, Yaremko L, et al. Pseudomembranous tracheobronchitis caused by Aspergillus. Am Rev Respir Dis 1991;143:1408–11.[Medline]

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