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May 20, 2026American Journal of Respiratory and Critical Care Medicine0 citations

A69-11 Invasive Aspergillus Tracheobronchitis in a Patient With Newly Diagnosed HIV Infection

GMG MichaeliThe University of Texas Southwestern Medical Center MWM E WalserThe University of Texas Southwestern Medical Center AHA M HuttonThe University of Texas Southwestern Medical Center

Key Points

To present a case of invasive aspergillus tracheobronchitis in a patient with newly diagnosed HIV infection and lymphoma.
Clinical presentation included abdominal pain, weight loss, and severe immunosuppression due to HIV with CD4 count of 9.
Diagnosis confirmed via bronchoscopy, BAL culture, and elevated serum galactomannan index.
Patient was treated with voriconazole and broad-spectrum antibiotics during hospitalization.
Patient developed acute respiratory failure and died from septic shock and multiorgan failure after diagnosis.
Bronchoscopy revealed necrotic tissue and Aspergillus flavus was cultured from BAL.
Galactomannan index was elevated, confirming invasive pulmonary aspergillosis as the cause of IFT.

Abstract

Abstract 25-year-old male presented with two-weeks of abdominal pain, malaise and 50 lb weight loss. In the ED, he was febrile and tachycardic. Initial workup revealed pancytopenia, AKI and DIC. CT abdomen/pelvis showed diffuse lymphadenopathy and splenomegaly, suspicious for lymphoma. Further workup revealed a new diagnosis of HIV (viral load 26,000; CD4 count 9). Core lymph node biopsy showed atypical lymphocytes positive for EBV. He was diagnosed with high grade B cell lymphoma and initiated on EPOCH regimen chemotherapy. His clinical course was complicated by CMV viremia, HLH requiring IVIG and IL-1 receptor antagonist (Anakinra), renal failure requiring RRT and profound neutropenia. He was treated with broad-spectrum antibiotics and antivirals, including prophylactic acyclovir, fluconazole and atovaquone. On hospital day 30, he developed acute hypoxemic respiratory failure, became increasingly encephalopathic and was intubated for airway protection. CT chest showed interval development of numerous patchy consolidative and nodular opacities with surrounding ground glass throughout the lungs bilaterally. Bronchoscopy of the trachea and mainstem airways revealed diffuse friable, necrotic tissue covered in a fine, filamentous white exudate (Fig 1) concerning for invasive fungal tracheobronchitis (IFT) and voriconazole was initiated. Serum aspergillus galactomannan was elevated at 8.381 units (negative: 0.5). On hospital day 35, the patient expired from progressive septic shock with multiorgan failure. Both BAL culture and bronchial wash later grew Aspergillus Flavus with BAL galactomannan index elevated at 8.526 units (negative: 0.5), confirming invasive pulmonary aspergillosis as the cause of IFT. Aspergillus tracheobronchitis (ATB) is a subtype of invasive pulmonary aspergillosis with several different forms including pseudomembranous, ulcerative and obstructive, with pseudomembranous being the most severe form1. ATB accounts for less than 10% of cases of invasive aspergillosis, mostly seen in immunosuppressed patients, such as lung transplant patients and those with AIDS2. Symptoms are nonspecific and mimic bacterial pulmonary infections. Clinicians should have a high index of suspicion in patients who do not improve with broad spectrum antibiotics. Radiographic findings are usually nonspecific. Diagnosis is made by bronchoscopy. Fungal cultures from the BAL will grow aspergillus and treatment is with voriconazole2. A delay in diagnosis of ATB results in increased mortality in an already highly fatal disease. 1.Lin CY, Fang YF. Predicting outcomes for invasive fungal tracheobronchitis. Eur Respir J. 2018;52(suppl 62). doi:10.1183/13993003.congress-2018.PA4690 2. Singhatiraj E, Tiengburanatarm K, Pongpirul K. Aspergillus Tracheobronchitis With Mediastinal Lymphadenopathy in a Patient With Well-Controlled HIV Infection. Case Rep Infect Dis. 2024;2024:9748358. doi:10.1155/crdi/9748358 This abstract is funded by: None

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