Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Airway-invasive aspergillosis
- Radiologic Findings
- Bronchoscopic biopsy for endobronchial lesion and BAL were done at Day 10. Bronchoscopy revealed diffuse hyperemia and yellowish exudates throughout the bronchi and mucosal ulcer like lesion in the left upper lobar bronchus. Asgergillus species were found in the BAL fluid and biopsy specimen.
The patient expired at Day 14 despite the systemic anti-fungal agent Voriconazole.
- Brief Review
- Pulmonary aspergillosis can be subdivided into five categories: (a) saprophytic aspergillosis (aspergilloma), (b) hypersensitivity reaction (allergic bronchopulmonary aspergillosis), (c) semi-invasive (chronic necrotizing) aspergillosis, (d) airway-invasive aspergillosis (acute tracheobronchitis, bronchiolitis, bronchopneumonia, obstructing bronchopulmonary aspergillosis), and (e) angioinvasive aspergillosis.
Airway-invasive aspergillosis is characterized at histologic analysis by the presence of Aspergillus organisms deep to the airway basement membrane. It occurs most commonly in immunocompromised neutropenic patients and in patients with AIDS. In this particular case, the patient had no specific predisposing factor for invasive aspergillosis except for COPD.
Clinical manifestations include acute tracheobronchitis, bronchiolitis, and bronchopneumonia. Patients with acute tracheobronchitis usually have normal radiologic findings, but sometimes, tracheal or bronchial wall thickening may be extensive and progress rapidly as seen in this particular case. Aspergillus bronchopneumonia results in predominantly peribronchial areas of consolidation. Rarely, the consolidation may have a lobar distribution.
- References
- Keywords
- lung, infection, fungal,