Pseudomembranous Tracheobronchitis Caused by Aspergillus in an Immunocompromised Patient-A Case Report

Abstract

Invasive aspergillosis is a leading cause of death in immunocompromised patients. We herein report a case of pseudomembranous tracheobronchitis caused by Aspergillus in an immunocompromised patient. A 45-year-old woman with diabetes mellitus presented with chest pain and cough. She was found to be in diabetic ketoacidosis and was treated for that and possible respiratory sepsis. She subsequently developed airway obstruction and respiratory failure. Bronchoscopic examination revealed pseudomembranous tracheobronchitis with granulation tissue obstructing several bronchi. The pseudomembrane consisted histologically of septate hyphae branching at 45°, consistent with Aspergillus species. Despite mechanical ventilation and antifungal therapy, the patient succumbed to progressive obstructive respiratory failure. Aspergillus tracheobronchitis should be considered in immunocompromised patients presenting with cough, chest pain, fever, dyspnea and upper airway obstruction. Early bronchoscopy and histologic examination should be performed and all clinical isolate of Aspergillus spp should be identified to species level because early definitive treatment may be life-saving.