Pseudomembranous tracheobronchitis caused by Aspergillus in a patient after peripheral blood stem cell transplantation
Koh, L.P.; Goh, Y.T.; Linn, Y.C.; Hwang, J.; Tan, P.
Annals of the Academy of Medicine Singapore 29(4): 531-533
2000
ISSN/ISBN: 0304-4602 PMID: 11056787 Document Number: 512753
Introduction: We report a case of pseudomembranous tracheobronchitis caused by Aspergillus fumigatus 2 years after matched unrelated stem cell transplant. Clinical Picture: The patient presented with dyspnoea and obstructive airway disease coinciding with the onset of chronic graft-versus-host disease (GVHD). Following treatment with higher immunosuppressive therapy for presumptive diagnosis of bronchiolitis obliterans, he subsequently developed recurrent spontaneous pneumomediastinum and progressive respiratory failure. Treatment and Outcome: Tracheobronchial biopsy and culture of bronchoalveolar lavage (BAL) fluid revealed Aspergillus tracheobronchitis. Despite mechanical ventilation and antifungal therapy, he succumbed to progressive respiratory failure. Conclusions and Clinical Implications: Aspergillus tracheobronchitis should be suspected in heavily immunosuppressed stem cell transplant recipients presenting with recurrent pneumomediastinum and progressive respiratory failure.