Spasova Maria I, Grudeva-Popova Janet G, Genev Evgeni D, Lazarova Antoaneta, Stoyanova Angelina A, Mumdjiev Ivan N
Department of Pediatrics and Medical Genetics, Medical University, Plovdiv, Bulgaria.
Folia Med (Plovdiv). 2006;48(3-4):93-7.
Acute tracheobronchitis is a rare clinical manifestation of respiratory tract invasive aspergillosis, sporadically reported in patients with hematological malignancies against the background of conventional chemotherapy. The authors report on a case of pseudomembranous necrotizing form of histologically proven tracheobronchitis, caused by Aspergillus spp in the time of induction chemotherapy in a patient with acute myeloid leukemia. The clinical evolution is gradual: from mild non-specific manifestations of acute tracheobronchitis against the background of a prolonged fever unaffected by antibiotic therapy to the onset of severe acute respiratory insufficiency and unilateral bronchial obstruction syndrome. Multiple spontaneous expectoration of a part of the bronchial wall was observed in which Aspergillus spp hyphae were histologically proven. Tracheobronchoscopy verified nearly complete obturation of the left main bronchus with thick mucous plugs. Lethal outcome from the infection occurred at the stage of hematological remission because of a massive hemoptysis. The diagnostic methods, therapeutic possibilities and differential diagnosis of this rare infectious complication in immunocompromised patients are discussed.
急性气管支气管炎是呼吸道侵袭性曲霉病的一种罕见临床表现，在接受传统化疗的血液系统恶性肿瘤患者中偶尔有报道。作者报告了一例组织学证实为假膜性坏死型气管支气管炎的病例，由曲霉菌属引起，发生在一名急性髓系白血病患者诱导化疗期间。临床病程是渐进性的：从急性气管支气管炎的轻度非特异性表现，在抗生素治疗无效的长期发热背景下，发展到严重急性呼吸功能不全和单侧支气管阻塞综合征的发作。观察到多次咳出部分支气管壁，组织学证实其中有曲霉菌属菌丝。气管支气管镜检查证实左主支气管几乎完全被浓稠的黏液栓阻塞。由于大量咯血，感染在血液学缓解阶段导致了致命后果。本文讨论了免疫功能低下患者这种罕见感染并发症的诊断方法、治疗可能性及鉴别诊断。
