Invasive Necrotizing Tracheobronchial Aspergillosis in Children: A Case Series and Literature Review

BACKGROUND Invasive tracheobronchial aspergillosis is rare in children. Here, we describe 3 cases in which mucosal necrosis and erosion were observed on bronchoscopy, with pseudomembrane-like attachments on the mucosal surface. CASE REPORT Case 1: An 8-year-old girl with leukemia was admitted because of recurrent fever, persistent cough (>1 month), and 1 day of hemoptysis. Chest computed tomography (CT) revealed progression of patchy opacities and consolidation in the right upper and middle lobes compared with prior imaging. Next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) detected Aspergillus flavus. Case 2: An 8-year-old girl with fever for 4 days and cough for 2 days was admitted. After admission, recurrent fever occurred; hemophagocytic syndrome and coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome were diagnosed. Sputum culture results were positive for A. fumigatus. Chest CT demonstrated atelectasis of the right upper lobe and left lower lobe. NGS of BALF also detected A. fumigatus. Case 3: A 4-year-old boy was admitted for mesenchymal stem cell infusion. He had undergone bone marrow transplantation 6 months prior to admission. Occasional cough and fever were reported. Chest CT indicated infectious lesions in both lungs. NGS detected A. fumigatus. Bronchoscopy in all 3 children revealed necrotizing tracheobronchitis. All patients were successfully treated and discharged in stable condition. CONCLUSIONS This report describes 3 cases of invasive pulmonary aspergillosis with invasive necrotizing tracheobronchial aspergillosis, highlighting diagnostic and management challenges, as well as a potential role for bronchoscopy in treatment of this disease.