Pseudomembranous Aspergillus tracheobronchitis

Date: 26 November 2013

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 2509 posts found.
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  • 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 (*);

  • 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);

  • 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).

  • Bronchoscopic manifestations of Aspergillus tracheobronchitis. (a) Type I. Inflammatory infiltration, mucosa hyperaemia and plaques of pseudomembrane formation in the lumen without obvious airway occlusion. (b) Type II. Deep ulceration of the bronchial wall. (c) Type III. Significant airway occlusion by thick mucous plugs full of Aspergillus without definite deeper tissue invasion. (d) Type IV. Extensive tissue necrosis and pseudomembrane formation in the lumen with airway structures and severe airway occlusion (Wu 2010).

    Bronchoscopic manifestations of <em>Aspergillus</em> tracheobronchitis. (a) Type I. Inflammatory infiltration, mucosa hyperaemia and plaques of pseudomembrane formation in the lumen without obvious airway occlusion. (b) Type II. Deep ulceration of the bronchial wall. (c) Type III. Significant airway occlusion by thick mucous plugs full of <em>Aspergillus</em> without definite deeper tissue invasion. (d) Type IV. Extensive tissue necrosis and pseudomembrane formation in the lumen with airway structures and severe airway occlusion (Wu 2009).

  • High resolution CT showing centrilobular nodular opacities and branching linear opacities (tree-in-bud appearance) (Al-Alawi 2007).

    Figure 6: High resolution CT showing centrilobular nodular opacities and branching linear opacities (tree-in-bud appearance) (Al-Alawi 2007).

  • Chest X-ray showing poorly defined bilateral nodular opacities (Al-Alawi 2007).

    Chest X-ray showing poorly defined bilateral nodular opacities (Al-Alawi 2007).

  • Mucus plugs seen obstructing the lumen of the bronchi (Kramer 2005).

    Obstructing tracheobronchitis. Mucus plugs seen obstructing the lumen of the bronchi (Kramer 2005).

  • Gross pathologic specimen from autopsy shows the bronchial lumen covered by multiple whitish endobronchial nodules (arrows) (Franquet 2002).

    Gross pathologic specimen from autopsy shows the bronchial lumen covered by multiple whitish endobronchial nodules (arrows) (Franquet 2002).

  • Invasive tracheobronchitis showing numerous nodules seen during bronchoscopy (Ronan D’Driscoll).

    Invasive tracheobronchitis showing numerous nodules seen during bronchoscopy (Ronan D’Driscoll).

  • Pseudomembranous seen overlying the bronchial mucosa (Tasci 2006).

    Pseudomembranous seen overlying the bronchial mucosa (Tasci 2006).


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