Pseudomembranous tracheobronchitis caused by Aspergillus in immunocompromised patients

Abstract

We report 2 cases of Aspergillus pseudomembranous tracheobronchitis in patients with diabetes. The first patient succumbed to progressive obstructive respiratory failure despite mechanical ventilation and antifungal therapy. However, the second patient survived. Aspergillus tracheobronchitis should be considered in immuno-compromised patients presenting with cough, chest pain, fever, dyspnea and upper airway obstruction. Early bronchoscopy and histologic examination should be performed. Early, appropriate treatment may be life saving.

Pseudomembranous Aspergillus Tracheobronchitis in an Immunocompetent Patient

“…The patient described herein showed a favorable response to antifungal therapy, as opposed to severely immunocompromised patients. This corresponds with previous reports 8,9,11 in which ATB patients with modest immune impairment improved with prompt antifungal therapy. These findings suggest that the outcome of antifungal therapy against ATB depends largely on the immune status of the patient.…”

“…IPA develops not only in immunocompromised patients, but is also increasingly recognized in ICU patients with COPD 13 , suggesting that ATB patients are usually less immunocompromised compared to those with IPA 6 . Until now, ATB has been reported in less immunocompromised patients, such as after influenza 8 , COPD 9 and diabetes 9,11 . However, no predisposing condition was recognized for IPA and no flu-like symptoms were noted in the case described herein, although the patient did not undergo serological examination for viral illnesses, such as influenza.…”

“…ATB usually occurs in neutropenic or severely immunocompromised hosts, including patients receiving cytotoxic chemotherapy [3][4][5] , patients with AIDS 5 , or in patients following bone marrow transplantation 6,7 . However, ATB has occasionally been reported in patients who are not fully immunocompetent, such as following influenza infection 8 , chronic obstructive pulmonary disease (COPD) 9,10 , and diabetes 9,11 . ATB has not heretofore been reported in an immunocompetent patient.…”

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).…”

Aspergillus pseudomembranous necrotizing tracheitis

“…There are very few reports of Aspergillus pseudomembranous necrotizing tracheitis in acute leukemia patients. [2,3] Our patient received intravenous voriconazole and G-CSF to aid the recovery. A repeat computed tomographic imaging showed decreased thickening of tracheal wall; therefore, she was discharged for follow-up in the clinic.…”