Invasive Tracheal Aspergillosis Treated Successfully with Voriconazole: Clinical Report and Review of the Literature

Abstract

Objectives: Invasive tracheal aspergillosis is a rare and highly fatal fungal infection that manifests as a progressive airway obstruction in immunocompromised patients. Otolaryngologists should be familiar with the entity of invasive necrotizing tracheal aspergillosis. Methods: In this report we describe a young patient with acute myeloid leukemia who was affected by invasive tracheal aspergillosis. This entity and the relevant literature are reviewed. Results: On the basis of the presented clinical report, we discuss the clinical and pathologic characteristics of invasive tracheal aspergillosis as an opportunistic infection. The classic symptoms are of progressive dyspnea in an immunosuppressed patient. Diagnosis is via pathological evidence of fungal hyphae invading the endoluminal upper respiratory tree. The present patient was successfully treated with an azole antifungal agent, combined with tracheostomy for airway control. Conclusions: Invasive tracheal aspergillosis is a life-threatening fungal infection that affects immunosuppressed patients. Because the mortality rate is high, awareness of this entity is essential for early diagnosis and treatment. A favorable outcome in this type of invasive aspergillosis correlates with resolution of the bone marrow suppression and early antifungal medical therapy combined with aggressive surgical intervention for airway control, if needed.