Multi-Misdiagnosis Analysis of One Case of Tracheobronchial Aspergillosis and Reflection of Corrected Treatment

XIA Jing-wen; DONG Liang

doi:10.3969/j.issn.1002-3429.2016.04.016

Abstract：Objective To investigate the clinical characteristics of tracheobronchial aspergillosis, so as to reduce misdiagnosis rate. Methods A case of tracheobronchial aspergillosis diagnosed in Huashan Hospital was analyzed and rele-vant literatures were reviewed. Results A 47-year-old female patient suffered from recurrent cough, sputum with fever and dyspnea for 20 days. The X-ray showed exudation lesion in both lungs, and the patient was misdiagnosed as having community acquired pneumonia, and one week of anti-inflammatory treatment was ineffective. After the patient was admitted to our hospi-tal, the chest CT showed more serious patchy shadows in both lungs, and severe community acquired pneumonia was diag-nosed. The chest CT showed no better signs after five days of anti-inflammation therapy. Then the patient was given bronchos-copy. We saw a lot of white fur-like substances in the main and sub-segmental bronchi. The diagnostic anti-tuberculosis treat-ment was given for one week, but the symptoms actually worsened. The pathological results of bronchoscopy suggested asper-gillosis infection. Intravenous itraconazole for one week had no effect. After the addition of amphotericin B aerosol therapy for one week, the symptoms improved significantly. Now the patient continued inhalation of amphotericin B and taking itracon-azole and her condition was stable after 4 months of follow-up. Conclusions Tracheobronchial aspergillosis progresses quickly and can be easily misdiagnosed. Specific clinical manifestations and imaging findings are lacking. Bronchoscopy and tissue bi-opsy are of great value in the diagnosis. Therapy combined with local and systemic anti-fungal should be taken immediately af-ter diagnosis.