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Aspergillus Bronchitis at Localised Mucus Plug in an Immunocompetent Patient

Summary

A 55-year-old woman developed a rare fungal infection called Aspergillus bronchitis in a mucus plug within her lung over a 9-year period. Although she was otherwise healthy with a normal immune system, the fungus gradually grew and eventually caused serious bleeding in her lungs. Doctors treated the bleeding with artery embolization and then surgically removed the affected lung tissue. The fungus was identified as Aspergillus udagawae, a type that is harder to treat with standard antifungal medications.

Background

Aspergillus tracheobronchitis (AT) is a rare form of invasive aspergillosis that typically occurs in immunocompromised patients. Few cases of AT have been reported in immunocompetent individuals. This case describes an unusual presentation of Aspergillus bronchitis developing in a mucus plug within localized bronchiectasis in an immunocompetent patient.

Objective

To report and characterize a case of Aspergillus bronchitis caused by Aspergillus udagawae in an immunocompetent 55-year-old woman with localized bronchiectasis and a mucus plug that gradually enlarged over 9 years.

Results

The mucus plug gradually enlarged over 9 years, eventually causing sub-massive hemoptysis. Bronchial artery embolization provided temporary relief. Left lingual segmentectomy was performed, revealing fungal hyphae filling the bronchial lumen with inflammatory cell infiltration and fungal invasion into pulmonary arteries. Culture identified Aspergillus udagawae. No hemoptysis recurrence occurred in the 10 months following surgery.

Conclusion

Non-invasive Aspergillus bronchitis can develop in mucus plugs of immunocompetent hosts, presenting a chronic course similar to chronic pulmonary aspergillosis in peripheral lungs. Surgical resection is an effective treatment option for localized lesions, and proper identification of cryptic Aspergillus species is important for determining appropriate treatment strategies.
  • Published in:Respirology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40114996, DOI: 10.1002/rcr2.70104
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