Pseudomembranous Aspergillus tracheobronchitis

Date: 26 November 2013

  • (A) Tracheal appearance at autopsy (after removal of slough) showing remarkable erythema and ulceration down to carina (Tait 1993).

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Pt FT. Autopsy appearance of the trachea, after the adherent pseudomembrane had been removed, revealing confluent ulceration superiorly with small green plaques of Aspergillus growth on the trachea inferiorly.

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Notes:

This patient had an acute onset of neutropenia, of undetermined origin, which was treated with prednisolone, before developing rapidly progressive and ultimately fatal pseudomembranous Aspergillus tracheobronchitis. His case was reported because he developed a unilateral monophonic wheeze, which prompted a diagnostic bronchoscopy.Tait RC, O’Driscoll BR, Denning DW. Unilateral wheeze due to pseudomembranous Aspergillus tracheobronchitis in the immunocompromised patient. Thorax 1993; 48: 1285-1287. Disseminated aspergillosis was found at autopsy and cultures from each organ were found to be clonal (Birch M, Nolard N, Shankland G, Denning DW. DNA typing of epidemiologically-related isolates of Aspergillus fumigatus. Infect Epidemiol 1995; 114: 161-168.)

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Showing 10 posts of 2574 posts found.

  • Title

    Legend

  • Hickman Line

    Hickman line

  • Percutaneous lung biopsy

    Percutaneous biopsy needle is seen vertically above the back

    Percutaneous biopsy needle is seen vertically above the back

  • Hickman line

    Chest Xray showing the normal course of a Hickman line

    Chest Xray showing the normal course of a Hickman line

  • PtDS2 – Repeated chest infections halted by itraconazole in ABPA and bronchiectasis

    PtDS2 –Repeated chest infections arrested by itraconazole therapy in ABPA and bronchiectasis

    DS2 developed asthma age 24 and now aged 62. From about age 30 she started getting repeated chest infections and a few years later ABPA and bronchiectasis was diagnosed. Infections continued requiring multiple courses of antibiotics annually. At one point DS2 developed a pneumothorax, possibly because of excess coughing. She has chronic rhinitis and mannose binding lectin deficiency. In May 2011, she started itraconazole therapy, and has needed no antibiotic courses for her chest since. Her rhinitis with sinusitis occasionally bothers her. She is delighted to have gone 18 months with no chest infections.

    Image A., Image B., Image C.

  • Sputum typical of bronchiectasis

    Image 2

    IMG_2194med

  • Sputum typical of bronchiectasis

    Image 1

    IMG_2195med

  • Airways (tracheobronchial)

    Aspergillus hyphae (arrow) in the lumen without invasion of the necrotic bronchial wall (*) (Nicod 2001).

    Aspergillus hyphae (arrow) in the lumen without invasion of the necrotic bronchial wall (*) (Nicod 2001).

  • Airways (tracheobronchial)

    fibrinonecrotic material (arrow) from the airway shown in A, with subocclusion of the bronchial lumen (*)

    fibrinonecrotic material (arrow) from the airway shown in A, with subocclusion of the bronchial lumen (*);

  • Airways (tracheobronchial)

    Fibrinous or pseudomembranous bronchitis (arrow) with subocclusion of the airways (* indicates subocclusion of the airways by pseudomembranes)

    Fibrinous or pseudomembranous bronchitis (arrow) with subocclusion of the airways (* indicates subocclusion of the airways by pseudomembranes);

  • Airways (tracheobronchial)

    Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×400).

    Bronchoscopic biopsy demonstrated septate hyphae with branching at 45o (methenamine silver stain ×400).