Pseudomembranous necrotizing bronchial aspergillosis.

Abstract

We report a case of pseudomembranous necrotizing bronchial aspergillosis in a patient with acute myelocytic leukaemia who died of massive haemoptysis. Lobar collapse was demonstrated on chest radiography. CT showed a marked necrotic thickening of the lobar bronchus with extension of the disease in to the peribronchial region.

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] .…”

“…El aseo bronquial mediante fibrobroscopia, realizado en esta paciente, parece ser eficaz en la eliminación de los tapones de mucus y pseudomembranas, lo que permite revertir los episodios de obstrucción de vía aérea superior, la generación de mecanismos de válvula, y por ende atrapamiento de volumen y auto PEEP. La eliminación de las masas de micelios puede ser útil debido a la escasa penetración de los antifúngicos en las masas de hongos 29 , pero puede aumentar el riesgo de complicaciones hemorrágicas ya que se podrían producir hemorragias fatales al eliminar pseudomembranas necrotizantes que se han extendido a través de la pared bronquial hacia vasos pulmonares 18 . Debemos enfatizar por tanto la broncoscopia a manos de personal experto, tanto en el diagnóstico como en el tratamiento de esta grave patología.…”

Complications of chronic necrotizing pulmonary aspergillosis: review of published case reports

“…Aspergillus tracheobronchitis was confined, at least initially, to the airways with only a superficial mucosal invasion, and the diagnosis was delayed because of non-specific signs, symptoms, and lack of radiographic abnormalities 11 . Pseudomembranous necrotizing tracheobronchial aspergillosis has been reported recently as an uncommon form of airway invasive aspergillosis in immunocompromised patients 10,12-15 . In a review of the literature on Aspergillus tracheobronchitis, including all forms of tracheobronchial involvement, reports indicated that the disease was progressive and fatal in about 40% of cases 10,13-15 .…”

“…This was apparently a lethal variant of tracheobronchial aspergillosis with a markedly higher mortality rate and more parenchymal lung involvement (65%) compared with all cases of Aspergillus tracheobronchitis (45%) 10,15 . It presents an extensive transmural necrotizing bronchitis with pseudomembrane formation that develops in immunocompromised patients, and it is usually characterized by a limited extension of inflammation and hyphae into the peribronchial tissue, without an invasion of the pulmonary parenchyma 10,12 . Involvement of the bronchial tree can be invasive, leading to a pseudomembranous tracheobronchitis with extensive bronchial hemorrhage and invasion of the bronchial walls and vessels.…”

“…Involvement of the bronchial tree can be invasive, leading to a pseudomembranous tracheobronchitis with extensive bronchial hemorrhage and invasion of the bronchial walls and vessels. In the literature review, we found reports of 22 cases with this variant of tracheobronchial involvement by Aspergillus 12-15 . There are published only five reports of this disease developing in an immunocompetent or mildly immunocompromised patient.…”