BACKGROUND The development of respiratory infections secondary to Aspergillus spp. spores found ubiquitously in the ambient environment is uncommon in immunocompetent patients. Previous reports of invasive upper airway aspergillosis in immunocompetent patients have generally demonstrated the efficacy of treatment regimens utilizing antifungal agents in combination with periodic endoscopic debridement, with symptoms typically resolving within months of initiating therapy. CASE PRESENTATION A 43-year-old previously healthy female presented with worsening respiratory symptoms after failing to respond to long-term antibiotic treatment of bacterial sinusitis. Biopsy of her nasopharynx and trachea revealed extensive fungal infiltration and Aspergillus fumigatus was isolated on tissue culture. Several months of oral voriconazole monotherapy failed to resolve her symptoms and she underwent mechanical debridement for symptom control. Following transient improvement, her symptoms subsequently returned and failed to fully resolve in spite of increased voriconazole dosing and multiple additional tissue debridements over the course of many years. CONCLUSIONS Invasive upper airway aspergillosis is exceedingly uncommon in immunocompetent patients. In the rare instances that such infections do occur, combinatorial voriconazole and endoscopic debridement is typically an efficacious treatment approach. However, some patients may continue to experience refractory symptoms. In such cases, continued aggressive treatment may potentially slow disease progression even if complete disease resolution cannot be achieved.

中文翻译：

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免疫功能不全的患者因系统性抗真菌治疗和连续手术清创而难治性侵袭性假膜上气道和气管曲霉病。

背景技术继发于曲霉属的呼吸道感染的发展。在具有免疫功能的患者中，在周围环境中普遍发现的孢子并不常见。先前有免疫能力的患者侵袭性上呼吸道曲霉病的报道一般证明使用抗真菌药联合定期的内镜清创术的治疗方案是有效的，症状通常在开始治疗后数月内得到缓解。病例介绍一名43岁以前健康的女性在对细菌性鼻窦炎的长期抗生素治疗无效后出现呼吸道症状加重。对她的鼻咽和气管进行活检显示有大量真菌浸润，并且在组织培养中分离出了烟曲霉。伏立康唑单药口服治疗数月未能缓解症状，并进行了机械清创术以控制症状。经过短暂的改善后，尽管伏立康唑的剂量增加，并且在许多年中多次组织清创，但她的症状随后又恢复了并且无法完全缓解。结论在免疫功能正常的患者中，侵袭性上呼吸道曲霉病极少见。在极少发生此类感染的情况下，伏立康唑联合内镜清创术通常是一种有效的治疗方法。但是，有些患者可能会继续出现难治性症状。在这种情况下，即使无法完全治愈疾病，持续的积极治疗也可能减慢疾病的进展。