Report of a case of invasive aspergillus tracheobronchitis combined with alveobronchiolitis and without immune deficiency
Online published: 2015-08-27
Objective To explore the clinical characteristics of invasive aspergillus tracheobronchitis (IATB) combined with alveobronchiolitis and improve the understanding of this disease. Methods Clinical data of an IATB patient with alveobronchiolitis and without immune deficiency was reported and analyzed. Literature was reviewed to investigate the clinical manifestations and bronchoscopic characteristics. Results A 46 year-old female patient was admitted to the tolaryngology department due to hoarseness for 10 d and aggravation of breathing difficulty for 6 d. Clinical fiberoptic examination showed that white pseudomembrane attached to bilateral subglottis. Lung CT showed right middle lobe atelectasis and irregular flake density shadow in right middle lobe and lower lobe. On the second day of admission, the patient was transferred to the Department of Respiratory Medicine due to dyspnea. Bronchoscopy examination discovered more white attachment around the main airways 2-3 cm from glottis. Pathological examination showed a large number of Aspergillus hyphae and the patient was diagnosed with IATB combined with pneumonia. After 30 d of treatment by voriconazole, the symptoms of patient almost disappeared and the focus was absorbed. Literature review indicated that most IATB patients were ones with serious immune deficiency and IATB could also invade people with mild low immune function and health people. Conclusion The awareness of people with mild or no immune deficiency who develop invasive aspergillosis should be improved. If the reason of severe coughing and dyspnea of patients is unknown, IATB is a possible diagnosis. Timely diagnosis procedure should be performed and bronchoscopy examination should be conducted ASAP to determine the diagnosis. Tracheobronchial pseudomembrane should be histologically examined and bronchoalveolar lavage fluid (BALF) should be examined by PCR in order to improve the positive rate.
Key words: invasive aspergillus tracheobronchitis; bronchoscopy; diagnosis
HUANG Jing , SHEN Qing , WEN Xiu-fang , et al . Report of a case of invasive aspergillus tracheobronchitis combined with alveobronchiolitis and without immune deficiency[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2015 , 35(7) : 1087 . DOI: 11.3969/j.issn.1674-8115.2015.07.029
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