Traqueobronquitis obstructiva por Aspergillus fumigatus en un paciente inmunocompetente / Obstructive tracheobronchitis due to Aspergillus fumigatus in an immunocompetent patient

Antecedentes: La traqueobronquitis aspergilar (TBA) es una forma clínica infrecuente de aspergilosis pulmonar invasiva donde la afectación fúngica se limita al árbol traqueobronquial. Aunque las formas más graves, como la TBA pseudomembranosa y ulcerativa, son casi exclusivas de pacientes inmunocomprometidos, la forma obstructiva, más leve, puede cursar en pacientes sin déficit inmunitario. Caso clínico: Se presenta el caso de un varón de 32 años sin antecedentes de interés que es evaluado por presentar neumonía recidivante del lóbulo inferior derecho. En los estudios microbiológicos del esputo destacaba el crecimiento de Serratia marcescens y escaso crecimiento de Aspergillus fumigatus, que se interpretó como una contaminación de la muestra. La fibrobroncoscopia reveló al nivel B10 del lóbulo inferior derecho un tapón mucoso muy denso que no se pudo extraer; no hubo otros hallazgos macroscópicos de interés. Durante la hospitalización el paciente logró expectorar el tapón mucoso y presentó una importante broncorrea posterior; en los cultivos microbiológicos se observaron numerosas colonias de A. fumigatus. Se indicó tratamiento con voriconazol, lo que llevó a la resolución del cuadro, sin nuevas recidivas. Conclusiones: La TBA obstructiva se caracteriza por la producción excesiva de moco denso cargado de hifas que puede llegar a obstruir la luz de la vía aérea y generar neumonías postobstructivas recidivantes. Es importante considerar este diagnóstico en pacientes inmunocompetentes con infecciones respiratorias recurrentes que presentan aislamiento repetido de colonias de Aspergillus en el esputo, aunque sean en escasa cuantía

Background: Aspergillus tracheobronchitis (ATB) is an uncommon type of invasive pulmonary aspergillosis in which fungal involvement is limited to the tracheobronchial tree. While the more severe forms, such as pseudomembranous and ulcerative ATB, occur almost exclusively in immunocompromised patients, the milder obstructive form may occur in patients without immune deficiency. Case report: The case of a 32 year-old man with no previous history of illness, who was evaluated for recurrent right lower lobe pneumonia, is presented. Microbiological sputum studies revealed growth of Serratia marcescens, and a limited growth of Aspergillus fumigatus, the latter interpreted as a contaminant in the specimen. Bronchoscopy revealed a dense mucous plug at level B10 of the right lower lobe, which could not be removed; no other macroscopic findings of interest were observed. During his hospital admission, the patient expectorated the mucous plug and had a significant subsequent bronchorrhoea. A substantial number of colonies of A. fumigatus grown in the sputum cultures. The patient was given voriconazole, leading to a clinical resolution, with no recurrences. Conclusions: Obstructive ATB is characterised by the excessive production of thick, hyphae-laden mucus, which can obstruct the airway lumen and generate relapsing post-obstructive pneumonias. It is important to consider this diagnosis in immunocompetent patients with recurrent respiratory infections and who show repeated isolation of Aspergillus colonies in the sputum, even in small quantities

[Obstructive tracheobronchitis due to Aspergillus fumigatus in an immunocompetent patient]. / Traqueobronquitis obstructiva por Aspergillus fumigatus en un paciente inmunocompetente.

BACKGROUND: Aspergillus tracheobronchitis (ATB) is an uncommon type of invasive pulmonary aspergillosis in which fungal involvement is limited to the tracheobronchial tree. While the more severe forms, such as pseudomembranous and ulcerative ATB, occur almost exclusively in immunocompromised patients, the milder obstructive form may occur in patients without immune deficiency. CASE REPORT: The case of a 32 year-old man with no previous history of illness, who was evaluated for recurrent right lower lobe pneumonia, is presented. Microbiological sputum studies revealed growth of Serratia marcescens, and a limited growth of Aspergillus fumigatus, the latter interpreted as a contaminant in the specimen. Bronchoscopy revealed a dense mucous plug at level B10 of the right lower lobe, which could not be removed; no other macroscopic findings of interest were observed. During his hospital admission, the patient expectorated the mucous plug and had a significant subsequent bronchorrhoea. A substantial number of colonies of A. fumigatus grown in the sputum cultures. The patient was given voriconazole, leading to a clinical resolution, with no recurrences. CONCLUSIONS: Obstructive ATB is characterised by the excessive production of thick, hyphae-laden mucus, which can obstruct the airway lumen and generate relapsing post-obstructive pneumonias. It is important to consider this diagnosis in immunocompetent patients with recurrent respiratory infections and who show repeated isolation of Aspergillus colonies in the sputum, even in small quantities.