ABSTRACT
Ulcer and white mucosal protrusion that resembled paving stones in the trachea were revealed under bronchoscopy in our case. Pathology of the mucosa indicated a large number of fungal hyphae. The patient was diagnosed as having invasive aspergillus tracheobronchitis (IATB). The image under bronchoscopy is very rare.
Keywords: aspergillus tracheobronchitis, bronchoscopy, invasive pulmonary aspergillosis
Invasive aspergillus tracheobronchitis (IATB) is a very aggressive form of invasive pulmonary aspergillosis (IPA), where it presents as ulcerations, nodules, pseudo‐membranes, or plaques in the large airways. In our case, it appears as a paving stone−like mucosal protrusion under bronchoscopy.
A 57‐year‐old man presented with a 1‐week history of cough and fever. He had a history of type 2 diabetes for 10 years. Computed tomography (CT) of the thorax showed patchy shadows distributed along the airway, mainly in segments of the upper lobe of the left lung (Figure 1). Fibreoptic bronchoscopy performed via the endotracheal tube showed ulcer and white mucosal protrusions that resembled paving stones, in the trachea (Figure 2A–C) and white moss covered the left upper lobe bronchus (Figure 2D). Then, the bronchoalveolar lavage fluids (BALFs) were collected via bronchoscopy and tested by metagenomic next‐generation sequencing (mNGS). mNGS reported Aspergillus fumigatus in BALFs. We also performed a biopsy on the white, paving stone−like mucosal protrusion in the trachea. Pathology indicated that a large number of fungal hyphae were observed (Figure 2E). Based on radiological findings and microbiological evidence, the patient was diagnosed with invasive Aspergillus tracheobronchitis (IATB). Subsequently, the patient was treated with voriconazole.
FIGURE 1.
CT of the thorax showed patchy shadows distributed along the airway in segments of the upper lobe of the left lung.
FIGURE 2.
(A,B) Fibreoptic bronchoscopy showed ulcer in trachea. (C) Paving stone−like white mucosal protrusion in trachea. (D) White moss covered on the left upper lobe bronchus. (E) Pathology indicated large number of fungal hyphae. Haematoxylin and eosin staining: ×200.
IATB is a very aggressive form of invasive pulmonary aspergillosis (IPA), where it presents as ulcerations, nodules, pseudo‐membranes, or plaques in the large airways [1]. IATB is usually the result of a disrupted respiratory epithelium caused by viral lytic effects or following surgery [2, 3]. Systemic azoles treatment is effective in most patients, and voriconazole is strongly recommended. In our case, it appears as a paving stone−like mucosal protrusion under bronchoscopy.
Author Contributions
The author contributed to the writing, review, and final approval of the manuscript.
Ethics Statement
The participant gave informed consent to participate in the study before taking part. I attest that the patient described in the manuscript, or their proxy, has completed and signed the consent form provided by Respirology Case Reports. I attest that the original of the signed form is held by the treating institution.
Conflicts of Interest
The author declares no conflicts of interest.
Associate Editor: Takeshi Johkoh
Funding: The author received no specific funding for this work.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.