Abstract:
Objective: Description of the management of obstructive tracheobronchitis due to Aspergillus fumigatus infection in a patient with AIDS. Method: Case report. Results: A forty-three years old male homosexual patient with AIDS was admitted with cough, shortness of breath, and problems expectorating sputum. HIV infection was diagnosed five years ago. He had history of recurrent Candida esophagitis, a wasting syndrome, MAC infection, and CMV retinitis. Laboratory results: CD4: 8/microliter, neutrophils: 1,1/nl. Chest X-ray: Bilateral infiltrates suggesting PCP. Pneumocystis carinii could be confirmed in induced sputum. A regular TMP/SMX-PCP-regimen and treatment with Prednisolone was started. Despite G-CSF therapy neutropenia worsened. The patient developed progressive respiratory distress. Bronchoscopy seven days after hospitalization showed a diffuse tracheobronchitis with multiple ulcers and fibrinous plaques in the distal trachea. Several nodules were seen in both main stem bronchi. The lumen of the distal trachea was nearly occluded by a circular stenosis approx. one cm above the tracheal bifurcation. Aspergillus fumigatus could be confirmed in several cultures and histological examination of tracheal secretion and broncho-alveolar lavage. After initial therapy with Itraconazole we administered Amphotericin B (50 mg/d) and Flucitosine (7,5 g/d). Due to global respiratory insufficiency three days after bronchoscopy the patient was put on a respirator. Ten days later bronchoscopy showed an improvement of the Aspergillus-plaques but unchanged stenosis of the trachea. The stenosis was dilated using a balloon and a self expanding stent was implanted. Twenty-four hours later the position of the stent, which had been dislocated during the change of a tube, was corrected. The stent was well tolerated by the patient who could be weaned from the respirator without problems. Three weeks later bronchoscopy showed only a few small fibrinous plaques in the proximal trachea. The stent was partially covered by epithelium. The patient was continued on a six month treatment with Itraconazole. He could be discharged six weeks after hospitalization. At a follow-up visit six months later he complained about dry cough without dyspnea. Conclusions: Aspergillus tracheobronchitis can rarely be confirmed in AIDS patients during their life-time. To our knowledge this is the first case report of an AIDS associated obstructive Aspergillus tracheobronchitis treated by stent implantation beside administration of antifungal agents. We encourage to consider this therapeutic option in case of an obstructive tracheobronchitis.
Keywords: *Acquired Immunodeficiency Syndrome/COMPLICATIONS *Anti-Infective Agents/THERAPEUTIC USE *Aspergillosis/THERAPY *Bronchitis/THERAPY *Lung Diseases, Obstructive/THERAPY *Prednisolone/THERAPEUTIC USE *Tracheal Diseases/THERAPY *Trimethoprim-Sulfamethoxazole Combination/THERAPEUTIC USE 970130
M9713390
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
