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Role of COPD in a case of fatal Aspergillus niger tracheobronchitis
  1. Tracy Ashby1,
  2. Kevin Green1,
  3. Kimberly Marie Burcher2 and
  4. Mariam Louis1
  1. 1Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville, FL, USA
  2. 2Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
  1. Correspondence to Dr Tracy Ashby; tracy.ashby{at}


A man with chronic obstructive pulmonary disease (COPD) in his mid-60s was admitted for respiratory failure due to multifocal, necrotising pneumonia. Despite initial improvement with antimicrobial therapy, the patient developed hemoptysis and progressive infiltrates. Subsequent fungal cultures from his bronchoalveolar lavage were positive for Aspergillus niger and treatment with voriconazole was added for suspected invasive pulmonary aspergillosis (IPA). A repeat bronchoscopy revealed cobblestone lesions with mucosal friability throughout the lower trachea and bilateral mainstem bronchi. Endobronchial biopsy showed septated hyphae confirming the diagnosis of IPA. Despite appropriate therapy, the patient declined further and passed away on hospital day 11. Invasive infections with A. niger are infrequent, with a paucity of data on clinical course and outcomes. Our case adds to the current body of literature regarding the potential virulence of this species in patients with COPD.

  • Pneumonia (respiratory medicine)
  • Infectious diseases

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  • Contributors TA was involved in the care of patient, devised the project and outlined the main teaching points to be conveyed and also provided final review of the manuscript prior to submission to publication. KG worked on the drafting of manuscript, review of literature and acquisition of images necessary for publication. KMB drafted the initial copy of the manuscript and performed an extensive literature review to ensure originality of the case. ML is the chief editor of the manuscript, who cross checked all references, fixed grammatical errors and tailored the outline of research project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.