title: Pseudomembranous Aspergillus tracheobronchitis in a heart transplant recipient.
abstract: Aspergillus tracheobronchitis (AT) is an uncommon clinical presentation of pulmonary aspergillosis that frequently progresses to invasive pulmonary aspergillosis. Diagnosis of AT may be delayed because of its insidious onset, non-specific signs and symptoms, and scarcity of radiographic abnormalities. We report the case of a patient who received a heart transplant (HT) because of cardiac amyloidosis and who developed pseudomembranous AT. Possible risk factors concurrent in this case were splenectomy, lymphocytopenia, and previous cytomegalovirus infection. Chest computed tomography scan showed thickening of the left bronchi and a 'tree-in-bud' pattern with multiple small nodules. Bronchoscopic examination revealed raised yellowish pseudomembranous plaques on the tracheobronchial tree. Bronchoalveolar lavage and aspirate cultures yielded Aspergillus fumigatus. The patient recovered with voriconazole. Clinicians should be aware of AT as a potential cause of respiratory symptoms with few radiographic abnormalities in HT recipients, as delay in performing bronchoscopy could result in an unfavorable prognosis.
authors.affiliation: Department of Internal Medicine, Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain. antrammar@yahoo.es
authors.forename: A
authors.initials: A
authors.lastname: Ramos
authors.forename: J
authors.initials: J
authors.lastname: Segovia
authors.forename: M
authors.initials: M
authors.lastname: Gómez-Bueno
authors.forename: C
authors.initials: C
authors.lastname: Salas
authors.forename: M T
authors.initials: MT
authors.lastname: Lázaro
authors.forename: I
authors.initials: I
authors.lastname: Sanchez
authors.forename: L
authors.initials: L
authors.lastname: Pulpón
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001991:Bronchitis / Q000382:microbiology*; D001999:Bronchoscopy; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000382:microbiology; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use; D014136:Tracheitis / Q000382:microbiology*; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole