Fulminant tracheobronchial aspergillosis

Description

A man aged 56 years with a history of HIV and diffuse B-cell lymphoma (in remission) was referred to our institute for management of pancytopenia and acute kidney injury. Five days prior to the admission, the patient went to a dental clinic for tooth extraction; he was noted to have a rash on the lateral aspect of his tongue, extending through the oral cavity. On examination, he was alert, awake and oriented to time, place and person. Laboratory investigation revealed Hb: 8.3 mg/dL, WCC: 500 cells/mL and platelet: 70 000 cells/mL.

BUN/Cr was 47/3, CD4 count was 350 and HIV viral load was 10 K. Chest X-ray was unremarkable; CT scan chest revealed mediastinal lymphadenopathy. Bronchoscopy was scheduled for the evaluation of lymphoma reoccurrence. It revealed yellowish raised lesion throughout the distal trachea, right middle stream bronchus, left middle stream bronchus, right upper lobe bronchus and right lower lobe bronchus...

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