Pseudomembranous tracheobronchial aspergillosis: a rare manifestation of invasive aspergillosis in a non‐neutropenic patient with Hodgkin's disease

Abstract

Pseudomembranous tracheobronchial aspergillosis coincident with systemic pulmonary aspergillosis represents a rare manifestation of fungal infection in immunocompromized hosts. We report on a patient with recurrent Hodgkin's disease, showing this infectious pattern after treatment with corticosteroids within the antineoplastic schedule, whereas neutropenia--the main risk factor for mold infections--had not occurred. An impaired number of helper T lymphocytes was merely detected as an additional, but hypothetical risk factor, when investigating the status of immunosuppression. Treated systemically with amphotericin B, the patient recovered quickly, although reported mortality rates are disastrous. What is crucial for the clinical management is an early diagnosis by bronchoscopy and cultural proof of the pathogen followed by an adequate antifungal treatment.

Clinical and Histological Aspects of Toenail Onychomycosis Caused by <i>Aspergillus</i> spp.: 34 Cases Treated with Weekly Intermittent Terbinafine

“…A few species are involved in different human mycoses, although these fungi are normally considered common contaminants: in immunosuppressed patients, especially Aspergillus fumigatus and Aspergillus flavus may cause pulmonary aspergillosis, invasive aspergillosis and occasionally pseudomembranous tracheobronchial aspergillosis [16]. Aspergilloma can be observed in immunocompetent patients with pre-existing lung cavities.…”

Tracheobronchial Manifestations ofAspergillusInfections

“…Arriero et al found simultaneous obstructive and pseudomembranous necrotizing tracheobronchitis due to Aspergillus flavus in a diabetic patient with ALL [67]. Buchheidt et al reported a patient with Hodgkin lymphoma and pseudomembranous form of tracheobronchial aspergillosis in whom patchy ulcerations were also found in the trachea and bronchi [68]. Van Assen et al described “yellowish plaques, ulcerations and pseudomembranes” seen during bronchoscopy in a patient who underwent hematopoietic stem cell transplantation (HSCT) due to acute myeloid leukemia (AML) and who subsequently developed Aspergillus tracheobronchitis [69].…”

“…Dyspnea, inspiratory wheezes, fever, and nonproductive cough belong to the most commonly reported symptoms [66, 68–70]. Airway obstruction may result in atelectasis and severe respiratory failure [72].…”

“…The mortality rate related to Aspergillus infection was as high as 72.2% (only four patients survived). Buchheidt et al, who successfully treated one patient with Hodgkin disease and pseudomembranous Aspergillus tracheobronchitis, stress that the key factors which warrant a favorable outcome are an early diagnosis involving bronchoscopy with culture and pathology as well as an adequate antifungal therapy [68]. Although 12 out of 19 patients with isolated Aspergillus tracheobronchitis complicating various malignant and nonmalignant diseases reported by Wu et al survived, the only patient with underlying hematological malignancy (non-Hodgkin lymphoma) died of cerebral dissemination of aspergillosis [46].…”

Endobronchial Fungal Disease: An Under-Recognized Entity

“…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,…”