Three cases of bronchial stump aspergillosis: unusual clinical presentations and beneficial effect of oral itraconazole.

Bronchial stump aspergillosis (BSA), i.e. Aspergillus infection of bronchial granulation tissue surrounding endobronchial suture threads, is a very rare variant of localized suppurative bronchial Aspergillus infection. The majority of reported cases have occurred within one year after lung surgery. We present three more patients, in whom BSA occurred very late (4.5, 6 and 7 yrs) after pulmonary resection. Other unusual features were: complete absence of symptoms in one patient, and simultaneous occurrence of aspergilloma in another. Removal of the endobronchial suture probably constitutes the key therapy for BSA. In all three of our patients oral itraconazole resulted in clinical, histological and microbiological improvement. In conclusion, BSA should be considered in the differential diagnosis of haemoptysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possible. Furthermore, BSA can be associated with other clinical presentations of Aspergillus infection, e.g. aspergilloma. Finally, long-term oral itraconazole therapy may represent a valid alternative when removal of the suture is not feasible.