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Mycopathologia

, Volume 181, Issue 11–12, pp 885–889 | Cite as

Unique Case of Pseudomembranous Aspergillus Tracheobronchitis: Tracheal Perforation and Horner’s Syndrome

  • Emine Argüder
  • Ayşegül Şentürk
  • H. Canan Hasanoğlu
  • İmran Hasanoğlu
  • Asiye Kanbay
  • Hayriye Tatlı Doğan
Article

Abstract

Pseudomembranous aspergillus tracheobronchitis is an uncommon form of invasive pulmonary aspergillosis, and it is generally seen in immunocompromised patients. We report about a mildly immunocompromised case with pseudomembranous aspergillus tracheobronchitis, which caused tracheal perforation, and Horner’s syndrome. A 44-year-old female with uncontrolled diabetes mellitus, complaining of fever and dyspnea, was admitted to the hospital. She was hospitalized with community-acquired pneumonia and diabetic ketoacidosis. Insulin infusion and empirical antibiotics were firstly commenced. Bronchoscopy showed left vocal cord paralysis with extensive whitish exudative membranes covering the trachea and the main bronchi. Liposomal amphotericin B was added due to the probability of fungal etiology. Mucosal biopsy revealed aspergillus species. Second bronchoscopic examination demonstrated a large perforation in the tracheobronchial system. Despite all treatments, respiratory failure developed on the 25th day and the patient died within 2 days. Pseudomembranous aspergillus tracheobronchitis is fatal in about 78 % of all cases despite appropriate therapy. Early diagnosis and efficient antifungal therapy may improve the prognosis.

Keywords

Pseudomembranous aspergillus tracheobronchitis Aspergillosis Tracheal perforation Horner’s syndrome 

References

  1. 1.
    Smith JA, Kauffman CA. Pulmonary fungal infections. Respirology. 2012;17:913–26.CrossRefPubMedGoogle Scholar
  2. 2.
    Huang HD, Li Q, Huang Y, et al. Pseudomembranous necrotizing tracheobronchial aspergillosis: an analysis of 16 cases. Chin Med J. 2012;125:1236–41.PubMedGoogle Scholar
  3. 3.
    Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011;20:156–74.CrossRefPubMedGoogle Scholar
  4. 4.
    Agarwal R, Vishwanath G, Aggarwal AN, et al. Itraconazole in chronic cavitary pulmonary aspergillosis: a randomized controlled trial and systematic review of literature. Mycoses. 2013;56:559–70.CrossRefPubMedGoogle Scholar
  5. 5.
    Ljubic S, Balachandran A, Pavlic-Renar I, Barada A, Metelko Z. Pulmonary infections in diabetes mellitus. Diabetol Croat. 2004;33:115–24.Google Scholar
  6. 6.
    Tasci S, Glasmacher A, Lentini S, et al. Pseudomembranous and obstructive Aspergillus tracheobronchitis—optimal diagnostic strategy and outcome. Mycoses. 2006;49:37–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Franquet T, Müller NL, Oikonomou A, Flint JD. Aspergillus infection of the airways: computed tomography and pathologic findings. J Comput Assist Tomogr. 2004;28:10–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Aerni MR, Parambil JG, Allen MS, Utz JP. Nontraumatic disruption of the fibrocartilaginous trachea: causes and clinical outcomes. Chest. 2006;130:1143–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Simpson FG, Morgan M, Cooke NJ. Pancoast’s syndrome associated with invasive aspergillosis. Thorax. 1986;41:156–7.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bourque PR, Paulus EM. Chest-tube thoracostomy causing Horner’s syndrome. Can J Surg. 1986;29:202–3.PubMedGoogle Scholar
  11. 11.
    Blum G, Hörtnagl C, Jukic E, et al. New insight into amphotericin B resistance in aspergillus terreus. Antimicrob Agents Chemother. 2013;57:1583–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Emine Argüder
    • 1
    • 6
  • Ayşegül Şentürk
    • 2
  • H. Canan Hasanoğlu
    • 1
  • İmran Hasanoğlu
    • 3
  • Asiye Kanbay
    • 4
  • Hayriye Tatlı Doğan
    • 5
  1. 1.Department of Pulmonary Medicine, School of MedicineYıldırım Beyazıt UniversityAnkaraTurkey
  2. 2.Department of Pulmonary MedicineAnkara Atatürk Training and Research HospitalAnkaraTurkey
  3. 3.Department of Infectious DiseasesAnkara Atatürk Training and Research HospitalAnkaraTurkey
  4. 4.Department of Pulmonary MedicineIstanbul Medeniyet University Medical FacultyIstanbulTurkey
  5. 5.Department of PathologyAnkara Atatürk Training and Research HospitalAnkaraTurkey
  6. 6.Department of Chest Diseases, School of MedicineYıldırım Beyazıt UniversityAnkaraTurkey

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