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日本呼吸器学会英文誌 Respiratory Investigation
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Abstract

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Article in Japanese

Case Report

A case of Aspergillus tracheobronchitis with suspected complication of Pneumocystis pneumonia under immunosuppressive therapy

Hiroki Nakatsumi*  Satoshi Watanabe  Takafumi Kobayashi  Hideharu Kimura  Kazuo Kasahara  Seiji Yano 

Department of Respiratory Medicine, Kanazawa University Hospital
*Present address: Department of Respiratory Medicine, Ishikawa Prefectural Central Hospital

ABSTRACT

An 80-year-old man who had received methotrexate and baricitinib for rheumatoid arthritis was admitted to the hospital because of fever and difficulty moving. Bronchoscopy showed necrosis of the right middle lobe bronchus, and culture of the specimen was positive for Aspergillus fumigatus. Aspergillus tracheobronchitis was diagnosed. Chest CT showed diffuse ground-glass opacities, and bronchoalveolar lavage fluid was positive for Pneumocystis jirovecii polymerase chain reaction, which was suspected to be a complication of Pneumocystis pneumonia. Although rare, physicians should consider the possibility of these coinfections in immunocompromised patients. Bronchoscopy coupled with tissue biopsy is needed for accurate diagnosis of pulmonary lesions in patients with cellular immune dysfunction, as seen in this patient.

KEYWORDS

Aspergillus tracheobronchitis  Pneumocystis pneumonia (PCP)  Rheumatoid arthritis (RA)  Methotrexate  Baricitinib 

Received 7 Dec 2021 / Accepted 14 Jul 2022

AJRS, 11(5): 286-291, 2022

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