Aspergillus Bronchitis Causing Atelectasis and Acute Respiratory Failure in an Immunocompromised Patient

Abstract

Aspergillus tracheobronchitis is an uncommon clinical form of invasive aspergillosis with fungal infection limited entirely or predominantly to the tracheobronchial tree. We report a case of Aspergillus fumigatus bronchitis, diagnosed by fiberoptic bronchoscopy, with fungal growth completely occluding the left main bronchus leading to lung collapse and acute respiratory failure in a 60-year-old male with erythroleukemia and profound granulocytopenia.

Endobronchial Fungal Disease: An Under-Recognized Entity

“…Among 121 patients (both transplant recipients and other cases) retrieved from the literature, 1 patient had A. fumigatus and A. flavus [25], 2 had A. nidulans [8, 20], 4 had A. niger [1, 9, 12, 28] and4 had A. flavus [5, 15, 21, 28]. In 34 patients no species were identified [2,5,6,7, 16, 17, 27, 31, 34, 42] while the rest (63%) had A. fumigatus. …”

“…Reviewing the English literature, we recognized that the most common agents causing EBFI are Aspergillus spp. [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45], Coccidioides immitis [46] , agents of zygomycosis [6,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73], Candida spp. [6, 34,74,75,76], Cryptococcus neoformans [77,78,79,80,81,82,83,84,85,86,87,88], and Histoplasma capsulatum [89,…”

Pseudomembranous Aspergillus Tracheobronchitis in an Immunocompetent Patient

“…Early diagnosis and prompt antifungal therapy may lead to success in the treatment of ATB in immunocompetent patients, in contrast to the high fatality rate in immunocompromised patients. ATB is a rare and less well-recognized variant of IPA, which is limited entirely or predominantly to the tracheobronchial tree 3 . Similar to IPA in severely immunocompromised patients, ATB carries a very high mortality rate, especially when fungal growth obstructing the lumen leads to acute respiratory failure 3,4 .…”

“…ATB is a rare and less well-recognized variant of IPA, which is limited entirely or predominantly to the tracheobronchial tree 3 . Similar to IPA in severely immunocompromised patients, ATB carries a very high mortality rate, especially when fungal growth obstructing the lumen leads to acute respiratory failure 3,4 . According to the proposed classification by Denning 12 , ATB is classified into three forms: obstructive, pseudomembranous, and ulcerative types.…”

“…Aspergillus tracheobronchitis (ATB), one form of IPA, is uniquely localized to the tracheobronchial tree and characterized by ulcers and pseudomembrane formation 2 , although it can be accompanied by pneumonia. 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 .…”