Unusual invasive bronchial aspergillosis in a patient with acute lymphoblastic leukemia

Invasive tracheobronchial aspergillosis is an uncommon form of Aspergillus lung infection observed in immunocompromised patients. A 43-year-old patient diagnosed with acute lymphoblastic leukemia presented prolonged fever and hemoptysis during remission induction chemotherapy. The bronchoscopic examination showed pale mucosa with multiple raised white-colored nodules of 3 to 5 millimeters in diameter in all the bronchi. Hyphae of Aspergillus sp were observed in the biopsy of one of the nodules and in the examination of the bronchoalveolar lavage. Despite amphotericin B therapy, the patient developed bilateral necrotizing pneumonia and multiple abscesses in the brain and in the thyroid gland, and died. From a review of the literature in the Medline database, four similar cases (two in AIDS patients, one in lymphoma and the remaining case in an acute myeloid leukemia patient) have been reported.