A 35-year-old female received multiagent induction chemotherapy including corticosteroids for acute lymphoblastic leukemia. Around day 20 of her chemotherapy, she developed progressive dry cough, low-grade fever, and hoarseness. It appeared that she has a foreign body in her throat. However, her sputum culture grew Aspergillus terrus. Computed tomographic imaging of her chest revealed circumferential thickening of trachea and left main stem bronchus with endoluminal densities compatible with sloughed-off material (Image 1, arrow). Under bronchoscopic examination, a large white necrotic but firm pseudomembrane was found to obstruct the trachea up to 80% (Image 2) and the pseudomembranous mass was removed. Histopathology of the tissue confirmed extensive deposition of fungal-hyphae.
Aspergillus necrotizing tracheitis is a rare but life-threatening infection that affects immunosuppressed patients.  This condition is seen with Aspergillus fumigatus. Patients with acute leukemia are also severely immunosuppressed and a strong clinical suspicion of this unusual infection can be life saving for a patient. There are very few reports of Aspergillus pseudomembranous necrotizing tracheitis in acute leukemia patients. [2, 3] Our patient received intravenous voriconazole and G-CSF to aid the recovery. A repeat computed tomographic imaging showed decreased thickening of tracheal wall; therefore, she was discharged for follow-up in the clinic.