[An unusual cause of acute respiratory distress: obstructive bronchial aspergillosis]

[Aspergillus niger responsible for a tracheo-oesophageal fistula in an immunocompetent patient]

Tracheal or bronchial aspergillar locations are rare. They are mainly found in patients with general or localised immune deficiency. The authors report the case of a 53-year-old Vietnamese immunocompetent patient without any factors of risk who suddenly came down with a perforation syndrome indicating a tracheo-oesophageal fistula. The bronchial samples helped identify Aspergillus niger as the agent incriminated. Surgical treatment associated with an antifungal treatment provided a cure without any recurrence for 3 years.

Endobronchial Fungal Disease: An Under-Recognized Entity

Most fungi enter the human body via inhalation; however, endobronchial fungal infection (EBFI) seems to be a rare manifestation compared to pulmonary or systemic disease. This presentation seems to be related to environmental factors as well as to the host status. With the increasing popularity of flexible bronchoscopy, it is being recognized with a higher frequency. Bronchoscopic findings in EBFI vary from mild mucosal inflammation to central airway obstruction. We searched English literature related to the topic and found 228 total cases of EBFI: Aspergillus species (121), Coccidioides immitis (38), Zygomycetes (31), Candida species (14) Cryptococcus neoformans (13), and Histoplasma capsulatum (11). We have also included a single case of endobronchial Pseudallescheria boydii infection in a lung transplant recipient that has not been reported previously. Most patients were immunocompromised, exhibited systemic manifestations of the primary infection, and responded to appropriate therapy. EBFI should be included in the differential diagnosis of any form of airway lesions in immunocompromised patients, especially among residents from the endemic areas.