Aspergillus pseudomembranous necrotizing tracheitis

Abstract

A 35-year-old female received multiagent induction chemotherapy including corticosteroids for acute lymphoblastic leukemia. Around day 20 of her chemotherapy, she developed progressive dry cough, low-grade fever, and hoarseness. It appeared that she has a foreign body in her throat. However, her sputum culture grew Aspergillus terrus. Computed tomographic imaging of her chest revealed circumferential thickening of trachea and left main stem bronchus with endoluminal densities compatible with sloughed-off material (Image 1, arrow). Under bronchoscopic examination, a large white necrotic but firm pseudomembrane was found to obstruct the trachea up to 80% (Image 2) and the pseudomembranous mass was removed. Histopathology of the tissue confirmed extensive deposition of fungal-hyphae.Aspergillus necrotizing tracheitis is a rare but life-threatening infection that affects immunosuppressed patients. [1] This condition is seen with Aspergillus fumigatus. Patients with acute leukemia are also severely immunosuppressed and a strong clinical suspicion of this unusual infection can be life saving for a patient. 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.

Pseudocarcinomatous Hyperplasia of the Nose and Necrotic Tracheitis Associated with Acute Myeloid Leukemia

“…Necrotizing tracheitis and necrotizing tracheobronchitis are caused by severe inflammation, including invasive infectious diseases and mechanical ventilation with intratracheal intubation (7,9,14). Le et al reported a case of necrotizing tracheitis with acute lymphoblastic leukemia due to aspergillus infection under the condition of immunosuppression subsequent to chemotherapy (15). There are no previous reports of complications associated with necrotizing tracheitis in AML.…”

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

“…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). Treatment in the acute phase of the illness frequently requires insertion of an endotracheal tube into the inflamed airway, which may lead to the subsequent development of mucosal shedding and subglottic stenosis.…”

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

“…[5]Type 2 Diabetes and leukemiaallogeneic stem cell trans- plantation. Rhizopus sp.Progressive cough, dyspnea, nausea and emesisintravenous liposomal amphotericin B, inhaled amphotericin B, intravenous caspofunginDeceased (respiratory failure)Le et al. [13]Acute lymphoblastic leukemia.chemotherapy Aspergillus. Cough, fever, and hoarseness.Intravenous voriconazoleG-CSFImprovedArgüder et al.…”