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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 136-137

Pseudomembranous Aspergillus tracheobronchitis with secondary Acinetobacter baumannii pneumonia


Department of Pulmonary Medicine, Employee's State Insurance Corporation-Postgraduate Institute of Medical Sciences & Research, Basaidarapur, New Delhi 110 015, India

Date of Submission19-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Gothi Dipti
Department of Pulmonary Medicine, Employee's State Insurance Corporation-Postgraduate Institute of Medical Sciences & Research, Basaidarapur, New Delhi 110 015
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2222_19

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How to cite this article:
Mahismita P, Dipti G. Pseudomembranous Aspergillus tracheobronchitis with secondary Acinetobacter baumannii pneumonia. Indian J Med Res 2020;152, Suppl S1:136-7

How to cite this URL:
Mahismita P, Dipti G. Pseudomembranous Aspergillus tracheobronchitis with secondary Acinetobacter baumannii pneumonia. Indian J Med Res [serial online] 2020 [cited 2021 Jul 30];152, Suppl S1:136-7. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/136/316781

Patient's consent obtained to publish clinical information and images


A 69 yr old male was admitted to the intensive care unit of Employee's State Insurance Corporation-Postgraduate Institute of Medical Sciences & Research (ESI-PGIMSR), New Delhi, India, on June 2019, with acute respiratory failure. He was an ex-smoker and presented with complaints of cough and breathlessness since three years. There was increased cough, purulent sputum and fever since four days. He had well-controlled diabetes and ischemic heart disease since five years. He also gave a history of pulmonary tuberculosis six years back. Imaging studies showed bilateral patchy consolidation with cavitation [Figure 1]A, [Figure 1]B, [Figure 1]C. Sputum investigations were negative for tuberculosis and culture showed growth of Acinetobacter baumannii and Aspergillus fumigatus. The patient was given antibiotic treatment as per the sensitivity reports. Bronchoscopy performed showed multiple greyish white nodules (pseudomembranes) studded throughout the tracheobronchial tree which were adherent to the mucosal wall [Figure 2]A. Biopsy from the nodules were cultured which showed growth of A. fumigatus [Figure 3]. Bronchial washings also yielded A. baumannii and A. fumigatus. The diagnosis was confirmed to be pseudomembranous Aspergillus tracheobronchitis with pneumonia due to A. baumannii. Treatment with voriconazole for three months and appropriate antibiotics showed significant resolution of the lesions [Figure 2]B and [Figure 4]A, [Figure 4]B, [Figure 4]C.
Figure 1: (A) The chest radiograph at presentation, showing bilateral patchy consolidation. (B and C) represent the computed tomography scan in lung window showing bilateral consolidation with some cavitation. (B) Also showed a hazy opacity (arrow) within the tracheal lumen suggestive of pseudomembrane.

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Figure 2: (A) Represents the bronchoscopic images at various levels of the tracheobronchial tree showing multiple greyish white nodules adherent to the mucosal wall. (B) Significant resolution of the lesions on follow up bronchoscopy after treatment with voriconazole.

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Figure 3: The microscopic image obtained on lactophenol cotton blue stain of slide culture preparation showing hyphae and conidial heads of Aspergillus fumigatus (×10).

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Figure 4: (A) The chest radiograph and represent the computed tomography scan images and (B and C) in lung window after treatment showing resolution of the lung lesions and endotracheal pseudomembranes.

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Acknowledgment: Authors acknowledge Drs Sangita Gupta and Devki Verma, department of Microbiology ESI-PGIMSR, New Delhi, for providing illustrated microbiological images and their interpretations.

Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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