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A woman in her 60s with a history of end-stage renal disease who had a kidney transplant 9 months previously presented with progressive cough, dyspnea, and hoarseness. Her history also included chronic gastroesophageal reflux disease and a 14-pack-year smoking history. She initially presented 3 months prior with upper respiratory symptoms, which continued to worsen despite oral antibiotic therapy. Her cough became productive with white, frothy phlegm that was accompanied by fever, wheezing, hoarseness, and fatigue. Her dyspnea worsened in the supine position.
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Pathology results from supraglottic biopsy revealed branching, fungal microorganisms among superficial fragments of squamous epithelium. Culture and bronchoalveolar lavage results confirmed the diagnosis of Aspergillosis laryngotracheobronchitis.
Aspergillus tracheobronchitis (ATB) is an unusual form of pulmonary aspergillosis that is seen in fewer than 10% of aspergillosis-related cases.1 Patients with neutropenia and/or who are immunocompromised are at particular risk for ATB.2 Patients usually present with dyspnea, cough, and wheezing. Diagnosis of this rare entity is often delayed because of its nonspecific clinical presentation and lack of radiographic findings at early stages.3 Radiologic findings may include thickening of airways, patchy infiltrates, or no findings at all.1 Definitive diagnosis requires visualization with laryngoscopy or bronchoscopy and both pathological and microbiological biopsies.4
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Corresponding Author: David G. Lott, MD, Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054 (email@example.com).
Published Online: May 9, 2019. doi:10.1001/jamaoto.2019.0772
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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