Invasive Tracheobronchial Aspergillosis with Bronchial Ulcers Complicated by Nontuberculous Mycobacterial Disease

Abstract

Invasive tracheobronchial aspergillosis (ITBA) complicated by nontuberculous mycobacteria (NTM) is rare. An 88-year-old man was admitted for hemoptysis. Bronchoscopy revealed bronchial ulcers, and a tissue biopsy showed Aspergillus fumigatus. He was diagnosed with ITBA, which improved with voriconazole. During treatment, infiltrative shadows appeared in his lungs, and bronchoscopy was performed once again. A non-necrotic epithelioid granuloma and Mycobacterium intracellulare were detected in the biopsy specimen. He was diagnosed with NTM disease. It is important to note that tracheobronchial ulcers may cause hemoptysis and to identify the etiology and treat it appropriately when multiple bacteria are found.

Case Report: Sudden Fatal Hemorrhage in Ulcerative Fungal Laryngotracheitis—A Pediatric Case Report

“…Revising the literature, ulcerative disruption of respiratory tract, descending from invasive Aspergillus laryngotracheal infection, are reported in adults [e.g., (9,10,14,20,25,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)] and in adolescents (15 and 17 years old) (47,48) but not in pediatric patients. According to our knowledge, only Barnes et al (49) and Athanassiadou et al (50) described Aspergillus laryngotracheobronchitis in children (6 and 2 years old) affected by acute lymphocytic leukemia; however, in these cases, the characterizing elements included plaques and necrotic cells, whereas ulcerative lesions were not reported.…”