Pseudomembranous tracheitis caused by Aspergillus fumigatus in the setting of high grade T-cell lymphoma

Abstract

Pseudomembranous tracheitis (PMT) is a rare condition most commonly caused by fungal or bacterial infection that is characterized by a pseudomembrane that partially or completely covers the tracheobronchial tree. PMT is most commonly found in immunocompromised patient populations, such as post-chemotherapy, AIDS, post-transplant and hematological malignancies. Due to its rarity, PMT is often not included in the differential diagnosis. This case describes a 65 year old male with persistent fever and refractory cough despite high dose empiric antibiotics. Subsequent bronchoscopy with biopsy revealed pseudomembranous tracheitis due to Aspergillus fumigatus in the setting of T-cell lymphoma. PMT should be considered in the differential diagnosis of refractory cough in the immunocompromised population. However, it has been described in patients with nonspecific respiratory symptoms such as dyspnea, cough, and other airway issues.

Pseudomembranous Tracheobronchitis due to Mycobacterium tuberculosis

“…Other infectious etiologies, such as Bacillus cereus or Pseudomonas aeruginosa, have also been reported [8,9]. An underlying immune deficiency or recent viral infection is generally present in patients with infectious PMTB [10].…”

Simultaneous occurrence of invasive pulmonary aspergillosis and diffuse large B-cell lymphoma: case report and literature review

“…Only a few publications have reported this condition (Table 1) [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (see Table 1. Reported cases of synchronous opportunistic infection and lymphoma).…”

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

“…2,[5][6][7] Other pathogens that have been rarely associated with tracheal pseudomembrane formation include Pseudomonas species, Corynebacterium species, Bacillus species, Staphylococcus species, Diptheria species, Moraxella species and Chlamydia species. 2,8 There have been sporadic case reports in human literature of pseudomembrane formation secondary to bacterial agents in immunocompetent patients. 2 There has also been a single case report documenting the formation of pseudomembrane overlying the upper larynx, vocal cord, tracheal and right main stem bronchus following aspiration of alendronate in an 84-yearold woman.…”

“…2 , 5 – 7 Other pathogens that have been rarely associated with tracheal pseudomembrane formation include Pseudomonas species, Corynebacterium species, Bacillus species, Staphylococcus species, Diptheria species, Moraxella species and Chlamydia species. 2 , 8 There have been sporadic case reports in human literature of pseudomembrane formation secondary to bacterial agents in immunocompetent patients. 2…”

“… 1 Infectious tracheal pseudomembrane is characterised by extensive inflammation of the tracheo-bronchial tree with formation of a pseudomembrane that is composed of fibrin, leukocytes and sometimes organisms overlying a damaged airway mucosa. 2 , 8 For those cases that develop secondary to intubation, it has been postulated that hyper-pressure at the site of endotracheal cuff leads to necrosis of the tracheal mucosa and submucosa with subsequent exposure of the cartilage, chondritis and perichondritis. 1 , 10 – 13 …”