Pseudomembranous tracheobronchitis caused by Aspergillus in a patient after peripheral blood stem cell transplantation.

INTRODUCTION We report a case of pseudomembranous tracheobronchitis caused by Aspergillus fumigatus 2 years after matched unrelated stem cell transplant. CLINICAL PICTURE The patient presented with dyspnoea and obstructive airway disease coinciding with the onset of chronic graft-versus-host disease (GVHD). Following treatment with higher immunosuppressive therapy for presumptive diagnosis of bronchiolitis obliterans, he subsequently developed recurrent spontaneous pneumomediastinum and progressive respiratory failure. TREATMENT AND OUTCOME Tracheobronchial biopsy and culture of bronchoalveolar lavage (BAL) fluid revealed Aspergillus tracheobronchitis. Despite mechanical ventilation and antifungal therapy, he succumbed to progressive respiratory failure. CONCLUSIONS AND CLINICAL IMPLICATIONS Aspergillus tracheobronchitis should be suspected in heavily immunosuppressed stem cell transplant recipients presenting with recurrent pneumomediastinum and progressive respiratory failure.