Ulcerative and Plaque-Like Tracheobronchitis Due to Infection with Aspergillus in Patients with AIDS

Abstract

Tracheobronchitis is an uncommon manifestation of infection due to Aspergillus species, occurring in < 7% of cases of pulmonary aspergillosis. At least 58 cases of invasive aspergillus tracheobronchitis have been described since 1962. We describe four patients with AIDS, all of whom were severely immunocompromised, who had ulcerative tracheobronchitis due to Aspergillus species demonstrated histologically. Three patients had received corticosteroids or were neutropenic at presentation. At bronchoscopy, three patients had some degree of diffuse tracheobronchitis, multiple ulcerative or "plaque-like" inflammatory lesions, and occasionally nodules involving the mainstem and segmental bronchi. The remaining patient had a single deep ulceration of the proximal trachea. Aspergillus was isolated from biopsy specimens from all four patients. There were varied degrees of invasion of the mucosa, submucosa, and cartilage on histological examination in three patients, one of whom had evidence of disseminated aspergillosis. Two patients subsequently developed pulmonary parenchymal disease due to Aspergillus. A review of aspergillus tracheobronchitis, including a discussion of airway disease in patients infected with human immunodeficiency virus, is presented.

Pulmonary aspergillosis: a clinical review

“…The rest of the cases appear to have no particular risk factors other than advanced AIDS [19][20][21]. There is increased incidence of tracheobronchial involvement in these patients in addition to the usual clinical picture of IPA [21,31]. Since isolation of Aspergillus from respiratory secretions has poor predictive value for invasive IPA in AIDS patients, a histopathological diagnosis is usually required to establish the diagnosis [32].…”

Aspergilosis traqueobronquial necrotizante en paciente crítico

“…La mayor parte de los casos de aspergilosis traqueobronquial invasora reportados en la literatura se han observado en pacientes severamente inmunocomprometidos 13 , tanto trasplantados de órgano sólido 1,14,15 como de médula ósea 2,3 , además de pacientes con VIH 5,16 , neutropenia o tumores hematológicos 17,18 . Sin embargo, también se han descrito en pacientes menos inmunocomprometidos como pacientes con lupus eritematoso sistémico sin tratamiento inmunomodulador, diabéticos, enfermedad pulmonar obstructiva crónica, cirrosis hepática avanzada, usuarios tratamiento corticoidal o inclusive en ausencia de una inmunodeficiencia predisponente aparente [19][20][21][22][23][24] .…”

“…Se presenta preferentemente en enfermos con uso crónico de glucocorticoides, trasplantados de órganos sóli-dos, portadores de neoplasias hematológicas o en presencia de neutropenia severa prolongada [1][2][3][4][5] . El sistema más frecuentemente comprometido es el respiratorio, con un amplio espectro de presentación que incluye desde la rinosinusitis crónica hasta el aspergiloma 6 .…”

Recomendaciones para el tratamiento de la infección por Aspergillus spp.

“…La traqueobronquitis aspergilosa es una enfermedad casi exclusiva de los pacientes con sida, de los receptores de un trasplante de pulmón, o de los pacientes en tratamiento esteroideo prolongado [30][31][32] . Puede oscilar entre una simple traqueobronquitis con producción excesiva de moco e inflamación o traqueobronquitis ulcerativa con úlceras y seudomembranas que se sitúan preferentemente en la sutura del injerto pulmonar 33 .…”