Obstructive bronchial aspergillosis after heart transplantation.

Obstructive bronchial aspergillosis is a rarely observed consequence of Aspergillus infection. It occurs not only in patients with the acquired immunodeficiency syndrome (AIDS), but also after heart transplantation (HTx) if T cells are reduced markedly by the application of antithymocyte globulin (ATG) in addition to immunosuppression with corticosteroids. In contrast to invasive aspergillosis or Aspergillus tracheobronchitis, the course of this form of Aspergillus infection may not be accompanied by symptoms, because bronchial inflammation with pseudomembranes, ulcers or destruction of mucosa and intrapulmonary infiltrates are absent. To prevent invasive aspergillosis following HTx, intensive antifungal therapy is necessary in cases of bronchial obstructive aspergillosis, because this form of Aspergillus infection seems to represent a stage before recognizable invasive disease, as in other immunocompromised patients.