Invasive Aspergillus tracheobronchitis in a patient with hairy cell leukemia and previous Plasmodium falciparum infection

Abstract

Invasive Aspergillus tracheobronchitis is a relatively rare form of invasive pulmonary aspergillosis characterized by invasion of the tracheobronchial tree by Aspergillus spp. Invasive pulmonary aspergillosis is predominantly detected in severely immunocompromised patients. Notably however, pulmonary and tracheobronchial cases of invasive aspergillosis have also been reported, particularly in the context of severe malaria caused by Plasmodium falciparum. Herein, we present a case of invasive Aspergillus tracheobronchitis in a patient with hairy cell leukemia and previous Plasmodium falciparum infection. Aspergillus infection is entirely or predominantly confined to the tracheobronchial tree. Three different types of IATB have been described based on bronchoscopic findings; obstructive, pseudomembranous, and ulcerative [1]. Obstructive IATB is characterized by thick mucus plugs, while pseudomembranous IATB is characterized by extensive involvement of the tracheobronchial tree with a membranous layer covering the mucosal surface, and ulcerative IATB is associated with limited involvement of the tracheobronchial tree with focal, ulcerative, or plaque-like processes. IATB most commonly occurs in immunocompromised patients, though cases of isolated tracheobronchial aspergillosis have also been reported in mildly immunocompromised subjects [2-3], and more rarely in immunocompetent patients after infection with immunomodulatory microorganisms such as Plasmodium falciparum. Malaria-induced immunosuppression is apparent late in the acute or even during the recovery phase of the disease, occasionally leading to opportunistic infections including invasive aspergillosis [4-5]. IATB is a rapidly progressive and potentially fatal infection. Comparatively high mortality rates have been reported in severely immunosuppressed hosts including patients with hematological malignancies and transplant recipients [6]. Herein, we report a case of obstructive IATB in a patient with hairy cell leukemia and recent infection caused by Plasmodium falciparum.