Tracheobronchitis Due to Invasive Aspergillus fumigatus in a Male With HIV With Minimal Imaging Findings

Aspergillus tracheobronchitis (AT) is a rare manifestation of invasive aspergillosis. We present a case of tracheobronchitis caused by Aspergillus fumigatus in a 33-year-old male with neutropenia and known human immunodeficiency virus (HIV) infection with acquired immunodeficiency syndrome (AIDS). A 33-year-old male with HIV/AIDS presented to the hospital with symptoms of productive cough for over two months associated with subjective fevers, chills, and body aches. Computed tomography (CT) of the chest was significant for scattered sub-centimeter bilateral upper lobe nodules but otherwise normal. The patient underwent an extensive evaluation for his respiratory symptoms, including an initial sputum culture, which grew Haemophilus parainfluenzae in addition to preliminary fungal growth, prompting further evaluation with bronchoscopy. Bronchoscopy revealed diffuse adherent obstructive pseudomembranous plaques in the trachea and bilateral upper lobe segmental bronchi. Bronchoalveolar lavage cultures later grew Aspergillus fumigatus. Tracheobronchitis due to Aspergillus species is a rare cause of infection in patients with HIV. We believe that this case underscores the importance of further evaluation utilizing bronchoscopy in patients with AIDS who have respiratory symptoms despite mild abnormalities on chest CT. This approach can be used to rule out atypical endobronchial infections such as tracheobronchitis due to Aspergillus species.