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.
Pseudomembranous tracheobronchitis caused by Aspergillus is a rare and lethal variant of invasive aspergillosis. It has been reported in a few series of immunocompromised patients.
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