Case Report of a Child after Hematopoietic Cell Transplantation with Acute Aspergillus Tracheobronchitis as a Cause for Respiratory Failure

Abstract

Rapid respiratory failure due to invasive mycosis of the airways is an uncommon presentation of Aspergillus infection, even in immunocompromised patients, and very few pediatric cases have been reported. Patients with Aspergillus tracheobronchitis present with nonspecific symptoms, and radiologic studies are often noninformative, leading to a delay in diagnosis. Prompt initiation of adequate antifungal therapies is of utmost importance to improve outcome. We report the case of a 9-year-old girl with chronic myelogenous leukemia who developed respiratory distress 41 days after hematopoietic cell transplantation and rapidly deteriorated despite multiple interventions and treatment modalities.

Aspergillus Laryngotracheobronchitis in a Child with Primary Immunodeficiency

“…To relieve airway obstruction immediately, fungal materials are physically removed by bronchoscopy, especially in cases of a pseudomembranous type of Aspergillus. 7,11) In our experience, this procedure was helpful early in the diagnosis but was useless in the late phase because the pseudomembranes became thick and stuck firmly along the airway. Granulocyte colony-stimulating factor can also be used to stimulate neutrophil production and enhance phagocytic activity against fungi since a fall in the absolute quantity of neutrophils is strongly associated with a high mortality rate in AT.…”

The Important Role of Endoscopy in Management of Pediatric Pseudomembranous Necrotizing Tracheitis

“…Microscope images can aid in the correct diagnosis of patients with complex respiratory conditions of similar presentation ( 1 , 14 ). Bronchoscopic findings consisted of membranous plaques, thick respiratory secretions, ulceration, or denudation of airway mucosa ( 15 ). Endoscopy (flexible or rigid) also has an important role in both tracheal and bronchial tissue sampling for microscopic analysis and culture, and helps to avert the need for intubation ( 17 ).…”

Case Report: Sudden Fatal Hemorrhage in Ulcerative Fungal Laryngotracheitis—A Pediatric Case Report

“…Prompt initiation of systemic/local antifungal therapy and restoration of host defenses are fundamental to improve outcomes and patient survival. In fact, once the respiratory failure occurs, the prognosis is poor (10)(11)(12)(13).…”

“…Direct bronchoscopy for airway visualization combined with bronchial biopsy is reported to be the gold standard for early identification of the infection. Unfortunately, the procedure is not free from risks because of possible hemorrhage associated with the removal of the infected material ( 6 , 12 , 19 ). Death is usually due to multiple organ failure or airway obstruction and acute respiratory distress syndrome (ARDS) ( 6 ).…”