Abstract
A 12-year-old girl receiving chemotherapy for acute myeloid leukemia had a fever of unknown origin in spite of administration of micafungin. Her respiratory condition suddenly deteriorated. Her trachea was intubated, and positive pressure ventilation was initiated; however, her respiratory condition further deteriorated. Expiratory volume was considerably lower than inspiratory volume. Simultaneously, she developed severe hypotension and bradycardia, and tension pneumothorax was suspected. Emergent chest decompression was subsequently performed; however, her airway resistance was still high. Bronchoscopy was performed to remove a foreign body in the carina. Subsequently, her respiratory status improved. Histopathological examination revealed that the foreign body was a fibrinous blood clot mixed with fungal hyphae of Aspergillus niger. Life-threatening check valve formation due to tracheobronchial aspergillosis under positive-pressure ventilation may be rare; however, once it occurs, prompt establishment of an escape route for trapped air, such as thoracentesis, may be required.
Highlights
Tracheobronchial aspergillosis, an uncommon form of Aspergillus-related lung disease, is mainly observed in immunocompromised patients with acquired immunodeficiency disorder and those undergoing immunosuppressive therapy for hematological malignancies or solid organ transplantation [1, 2]
Large airway obstruction caused by invasive tracheobronchial aspergillosis may lead to respiratory failure
It has been suggested that invasive tracheobronchial aspergillosis may lead to fatal hemorrhage because of the development of a bronchovascular fistula [1, 2]
Summary
Tracheobronchial aspergillosis, an uncommon form of Aspergillus-related lung disease, is mainly observed in immunocompromised patients with acquired immunodeficiency disorder and those undergoing immunosuppressive therapy for hematological malignancies or solid organ transplantation [1, 2]. Micafungin administration was initiated because a fungal infection was suspected After confirming the release of the tension pneumothorax (Fig. 2), a regular chest drain tube was replaced with the intravenous cannula. After successfully removing the foreign body, her respiratory status gradually improved, and she was weaned from mechanical ventilation under amphotericin B administration. Her infectious status was under control with voriconazole medication. Histopathological examination revealed that the foreign body was a fibrinous blood clot mixed with numerous filamentous fungal hyphae of Aspergillus niger (Fig. 4)
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