Case of Pseudomembranous Necrotizing Tracheobronchial Aspergillosis in an Immunocompetent Host

Abstract

A 44-year-old Korean male died of rapidly progressive respiratory failure and refractory hypoxemia in 8 days after being admitted with a fever and dyspnea. The patient was diagnosed with pseudomembranous necrotizing tracheobronchial aspergillosis by fibroptic bronchoscopy and it was not related to an invasion of the pulmonary parenchyma. To the best of our knowledge, this case represents a patient with pseudomembranous necrotizing tracheobronchial aspergillosis that developed in an immunocompetent host, rapidly resulting in airway obstruction with acute respiratory failure and refractory hypoxemia without an invasion of the pulmonary parenchyma.

Pulmonary Fungal Diseases in Immunocompetent Hosts: A Single-Center Retrospective Analysis of 35 Subjects

“…The average time from first symptoms to diagnosis for aspergillosis, cryptococcosis, and mucormycosis was 123 (4-500) days, 37 (7-150) days, and 22 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) days, respectively. The chief clinical symptoms were cough (n = 27, 77.1 %), hemoptysis (n = 17, 48.6 %), moist crackles (n = 7, 20.0 %), and fever (n = 5, 14.3 %).…”

“…Cases have been reported in the USA, Spain, Germany, France, India, Korea, and Taiwan [7][8][9][10][11][12][13][14]. Unlike immunocompromised patients, pulmonary fungal disease in immunocompetent patients can be easily misdiagnosed due to the absence of the specific clinical and imaging manifestation, as well as a lack of recognition.…”

Invasive Tracheobronchial Aspergillosis in a Patient with Systemic Lupus Erythematosus-dermatomyositis Overlap Syndrome

“…To the best of our knowledge, only seven cases, including the present case, have been reported without any evidence of a severe immunosuppressive status (Table), such as solid organ and/or hematological malignancy, post-transplant, AIDS, insulin-dependent diabetes mellitus and steroids and/or immunosuppressive therapy (5,14,(16)(17)(18)(19)(20)(21). Four of the seven reported patients with ITBA were immunocompetent (5, 16, 19), and the others had either SLE/DM, tracheal and bronchial structural abnormalities such as tuberculosis (20) or COPD (21).…”

Pulmonary aspergillosis: Atypical presentation in immunocompetent individuals

“…Even with amphotericin B, higher antibacterial therapy, and supportive care, the patient died. [7] Massive hemoptysis has been reported in pulmonary fungal infection in patients with tuberculosis as the underlying disease. [8] A. flavus has also been reported to cause pulmonary aspergillosis in immunocompetent individuals, who presented with hydropneumothorax.…”