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Nodular invasive tracheobronchitis due to Aspergillus in a patient with systemic lupus erythematosus

Department of Anesthesia/Critical Care Medicine, Stanford University Hospital, Stanford, California, USA

G Krishna

Department of Pulmonary/Critical Care Medicine, Stanford University Hospital, Stanford, California, USA

J Scott

Department of Internal Medicine, Stanford University Hospital, Stanford, California,, USA

G Berry

Department of Pathology, Stanford University Hospital, Stanford, California, USA

A Weinacker

Department of Pulmonary/Critical Care Medicine, Stanford University Hospital, Stanford, California, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University Hospital, 300 Pasteur Drive, H3142, Stanford, CA 94305, USA annw{at}stanford.edu

Nodular or pseudomembranous tracheobronchitis due to infection by Aspergillus species is an uncommon presentation of invasive aspergillosis. Most cases have been described in severely immunocompromised hosts. We describe the case of a 23-year-old woman, with recently diagnosed systemic lupus erythematosus, who developed worsening respiratory function. Bronchoscopy revealed rapid developmentand progression of multiple nodular plaques in her trachea and bronchi. Endobronchial biopsy demonstrated invasive fungal infection with tissue necrosis and the presence of hyphal elements consistent with aspergillosis. To the best of our knowledge, this is only the second report of fulminant invasive tracheobronchitis due to Aspergillus in a patient with an autoimmune disease.

Key Words: aspergillosis • tracheobronchitis • systemic lupus erythematosus

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