Invasive Tracheobronchial Aspergillosis in a Patient with Systemic Lupus Erythematosus-dermatomyositis Overlap Syndrome

Abstract

A 45-year-old man was referred to our hospital with a 3-month history of dyspnea, polyarthralgia, myalgia and weight loss. He was diagnosed with systemic lupus erythematosus/dermatomyositis overlap syndrome with lung involvement, which presented as organizing pneumonia. However, a bronchoscopic examination revealed the presence of multiple plaque-like white lesions with ulcers on the bronchial membrane, located mainly in the central airway. The pathological specimens obtained from bronchoscopy showed numerous filamentous fungal hyphae that were aggressively invading the bronchial walls, suggesting a diagnosis of invasive tracheobronchial aspergillosis. The present case, along with a review of the literature, demonstrates that invasive tracheobronchial aspergillosis can occur in patients who do not appear to be immunosuppressed. This case of aspergillosis should thus be recognized as an extremely rare presentation of an Aspergillus infection.

Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management

“…Denning et al classified airway aspergillosis into four distinct types: pseudomembranous aspergillus tracheobronchitis (ATB), ulcerative ATB, obstructing and invasive ATB (65). The endobronchial appearance of infection can present with by wall edema, pseudomembranes, necrotizing pseudomembranous lesions, ulcerative lesions, whitish or yellowish plaques, endoluminal masses and vegetations (Figure 1) (57,58,(66)(67)(68)(69)(70)(71)(72)(73). Mucor and Rhizopus are the most commonly reported pathogens of mucormycosis.…”

Aspergilosis traqueobronquial necrotizante en paciente crítico

“…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] . El Aspergillus fumigatus es el organismo más frecuente seguido en frecuencia por A. flavus, A. niger y A. nidulans 7 .…”