Acute Respiratory Distress Syndrome Due to COVID-19-Associated Pulmonary Aspergillosis with Rare Extensive Tracheobronchial Pseudomembranous Involvement: A Case Report

Author: mycolabadmin
7/30/2025
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Summary

An 87-year-old man with COVID-19 developed a rare and severe fungal infection in his airways caused by Aspergillus fumigatus. Doctors used a camera tube (bronchoscope) to see thick, yellowish-white membrane-like material coating his entire windpipe and airways, which is an extremely rare complication. Despite starting antifungal medications, his condition rapidly worsened leading to organ failure and death. This case highlights how COVID-19 can leave patients vulnerable to serious secondary fungal infections that require immediate recognition and treatment.

Background

COVID-19-associated pulmonary aspergillosis (CAPA) significantly exacerbates clinical outcomes in COVID-19 patients, contributing to heightened mortality rates. SARS-CoV-2 induces epithelial damage and immunosuppression, increasing susceptibility to opportunistic fungal pathogens including Aspergillus species. Aspergillus tracheobronchitis is a rare manifestation of invasive pulmonary aspergillosis that involves the tracheobronchial tree.

Objective

This case report describes the first documented instance of pseudomembranous Aspergillus tracheobronchitis with extensive pseudomembranous involvement spanning the entire tracheobronchial tree from the glottis to the bronchi in an elderly COVID-19 patient. The report aims to highlight the clinical presentation, diagnostic challenges, and outcomes of this rare manifestation of CAPA.

Results

Bronchoscopy revealed extensive yellowish-white, transparent pseudomembranes enveloping the entire subglottis, trachea, and bronchi with underlying mucosal hyperemia and edema. Histopathological examination and NGS analysis confirmed Aspergillus fumigatus infection (92.4% of identified pathogens). Despite antifungal therapy initiation, the patient developed multiorgan failure and died on January 18, 2023.

Conclusion

This case demonstrates the severe complications of COVID-19-associated pulmonary aspergillosis presenting as pseudomembranous tracheobronchitis. Early bronchoscopic diagnosis and immediate antifungal therapy are critical for improving patient outcomes. The rarity and high mortality of this manifestation underscores the necessity for heightened clinical suspicion in COVID-19 patients with risk factors for aspergillosis.

Published in:Mycopathologia,
Study Type:Case Report,
Source: PMID: 40742610, DOI: 10.1007/s11046-025-00971-5