Pseudomembranous necrotizing tracheobronchitis caused by Aspergillus spp--contribution of one case with acute myeloid leukemia.
Acute tracheobronchitis is a rare clinical manifestation of respiratory tract invasive aspergillosis, sporadically reported in patients with hematological malignancies against the background of conventional chemotherapy. The authors report on a case of pseudomembranous necrotizing form of histologically proven tracheobronchitis, caused by Aspergillus spp in the time of induction chemotherapy in a patient with acute myeloid leukemia. The clinical evolution is gradual: from mild non-specific manifestations of acute tracheobronchitis against the background of a prolonged fever unaffected by antibiotic therapy to the onset of severe acute respiratory insufficiency and unilateral bronchial obstruction syndrome. Multiple spontaneous expectoration of a part of the bronchial wall was observed in which Aspergillus spp hyphae were histologically proven. Tracheobronchoscopy verified nearly complete obturation of the left main bronchus with thick mucous plugs. Lethal outcome from the infection occurred at the stage of hematological remission because of a massive hemoptysis. The diagnostic methods, therapeutic possibilities and differential diagnosis of this rare infectious complication in immunocompromised patients are discussed.
Department of Pediatrics and Medical Genetics, Medical University, Plovdiv, Bulgaria.
Maria I
MI
Spasova
Janet G
JG
Grudeva-Popova
Evgeni D
ED
Genev
Antoaneta
A
Lazarova
Angelina A
AA
Stoyanova
Ivan N
IN
Mumdjiev
D000208:Acute Disease; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001228:Aspergillosis / Q000382:microbiology* / Q000473:pathology; D001230:Aspergillus / Q000302:isolation & purification* / Q000472:pathogenicity; D001991:Bronchitis / Q000382:microbiology* / Q000473:pathology; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D016867:Immunocompromised Host; D007951:Leukemia, Myeloid / Q000150:complications* / Q000188:drug therapy; D008172:Lung Diseases, Fungal / Q000382:microbiology* / Q000473:pathology; D008297:Male; D009336:Necrosis; D009894:Opportunistic Infections; D013902:Radiography, Thoracic; D014136:Tracheitis / Q000382:microbiology* / Q000473:pathology
D003561:Cytarabine; D005047:Etoposide; D015255:Idarubicin