Xiang-Qin Xu,1 Chun-Xing Ye,1 Na Li,1 Xin Yu,1 Yan-Fang Liao,2 Yan Shen1 

1Department of Respiratory, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong Province, People’s Republic of China; 2Department of Pathology, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong Province, People’s Republic of China

Correspondence: Yan Shen, Department of Respiratory, Longgang Central Hospital of Shenzhen, Shenzhen, Guangdong Province, 518116, People’s Republic of China, Tel +86 15817436007, Email yanshen2008@163.com

Purpose: Pseudomembranous Aspergillus tracheobronchitis (PMATB), an uncommon clinical form of invasive aspergillosis, is mainly occurs in patients who are moderate to severely immunocompromised. There are some case reports of immunocompetent individuals developing invasive aspergillosis after occupational exposure (Primarily observed in farmers, sawmill workers, waste collectors, mushroom processing workers, or those who handle grain, hay, or straw), including allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitization, hypersensitivity pneumonitis, and invasive pulmonary aspergillosis. To our knowledge, there are no published case reports in the literature with PMATB as the main presentation in construction worker after occupational exposure.
Case Presentation: We report a case of a 45-year-old construction worker who was previously healthy, presented with cough for one weak and dyspnea and wheezing for two days. Computed tomography (CT) of the chest was normal. He was misdiagnosed with severe asthma, and started on intravenous corticosteroids, together with an inhaled short-acting beta2 agonist and inhaled muscarinic antagonist and empirical anti-infective therapy. However, his symptoms were still progressing. Bronchoscopy revealed cream-colored plaques throughout the trachea and bronchial mucosa. Photomicrograph of tissue and culture of post-bronchoscopy sputum and bronchial aspirate showed aspergillus with branching and septate hyphae.
Results: The patient recovered quickly when treated systemically with voriconazole.
Conclusion: Our report presents an immunocompetent construction worker with no chronic diseases who developed invasive aspergillosis primarily manifesting as PMATB due to occupational exposure. This presentation is rare and has not been previously documented in the literature. Early diagnosis and prompt initiation of antifungal therapy may improve the outcome and decrease mortality rate.

Keywords: Pseudomembranous Aspergillus tracheobronchitis, bronchoscopy, immunocompetent, occupation exposure