Case Report

Not Your Typical Chronic Obstructive Pulmonary Disease Exacerbation: Aspergillus Tracheobronchitis in a Nonclassical Immunocompromised Host

Authors: Benjamin Thonar, MD, Mark Yoder, MD, Constance Cleaves, MD


he present study reports on a 72-year-old female initially treated as a presumed chronic obstructive pulmonary disease (COPD) exacerbation, but she was ultimately discovered to have Aspergillus tracheobronchitis. Bronchoscopic findings were characteristic, revealing diffuse plaque-like inflammatory lesions extending from midtrachea into the mainstem bronchi. Evidence suggests that the rise in cases is attributable to the growing number of individuals who are immunocompromised secondary to underlying disease, combined with the expanding number of patients receiving glucocorticoids and immunomodulating medications to treat chronic, nonmalignant disorders. The present observations emphasize the importance of including Aspergillus tracheobronchitis in the differential diagnosis for patients receiving medications with immunosuppressive potential that present with dyspnea, cough, or fever and who fail to improve with empiric antimicrobial therapy.

Key Points

* The incidence of invasive fungal infections, particularly invasive aspergillosis, is rising and expected to increase even further in coming years.

* Patients receiving medications with immunosuppressive potential that present with exaggerated dyspnea and fail to improve with empiric antimicrobial therapy should be evaluated for invasive aspergillosis.

* Corticosteroids and other immunosuppressive medications should be tapered to the lowest dose possible.

* Aspergillus tracheobronchitis should be considered in any chronic obstructive pulmonary disease (COPD) patient with worsening dyspnea and/or cough who fails to improve with empiric antimicrobial therapy.

* Patients with COPD and/or rheumatoid arthritis (RA) receiving immunomodulating therapy are at increased risk for invasive pulmonary aspergillosis (IPA).

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