Role of COPD in a case of fatal Aspergillus niger tracheobronchitis

BMJ Case Rep. 2023 Mar 22;16(3):e251807. doi: 10.1136/bcr-2022-251807.

Abstract

A man with chronic obstructive pulmonary disease (COPD) in his mid-60s was admitted for respiratory failure due to multifocal, necrotising pneumonia. Despite initial improvement with antimicrobial therapy, the patient developed hemoptysis and progressive infiltrates. Subsequent fungal cultures from his bronchoalveolar lavage were positive for Aspergillus niger and treatment with voriconazole was added for suspected invasive pulmonary aspergillosis (IPA). A repeat bronchoscopy revealed cobblestone lesions with mucosal friability throughout the lower trachea and bilateral mainstem bronchi. Endobronchial biopsy showed septated hyphae confirming the diagnosis of IPA. Despite appropriate therapy, the patient declined further and passed away on hospital day 11. Invasive infections with A. niger are infrequent, with a paucity of data on clinical course and outcomes. Our case adds to the current body of literature regarding the potential virulence of this species in patients with COPD.

Keywords: Infectious diseases; Pneumonia (respiratory medicine).

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / therapeutic use
  • Aspergillosis* / complications
  • Aspergillosis* / diagnosis
  • Aspergillosis* / drug therapy
  • Aspergillus niger
  • Bronchitis* / complications
  • Bronchitis* / diagnosis
  • Bronchitis* / drug therapy
  • Humans
  • Invasive Pulmonary Aspergillosis* / diagnosis
  • Male
  • Pulmonary Disease, Chronic Obstructive* / complications
  • Pulmonary Disease, Chronic Obstructive* / drug therapy

Substances

  • Antifungal Agents

Supplementary concepts

  • Aspergillus brasiliensis