Dynamic Bronchoscopic Evolution of a Cobblestone-like Appearance in COVID-19-associated Pulmonary Aspergillosis: A Case Report.

Authors

Toshihide Ishida, Nobuhiro Fujishima, Yoshio Satonaga, Marimu Yamanaka, Shota Omori, Ryuichi Takenaka, Ryuzo Abe, Kazuhiro Kawamura, Tsutomu Daa, Kosaku Komiya

Published in

Internal medicine (Tokyo, Japan). Oct 15, 2026. Epub Oct 15, 2026.

Abstract

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is associated with high mortality and diagnostic difficulties. We report a fatal case of CAPA with a distinctive cobblestone-like tracheobronchial appearance observed during bronchoscopy. A patient receiving maintenance hemodialysis for chronic kidney disease was admitted with severe COVID-19. Bronchoscopy revealed multiple white tracheobronchial plaques, suggestive of an invasive Aspergillus infection. Despite antifungal therapy, respiratory failure progressed, and repeat bronchoscopy revealed worsening cobblestone-like lesions. The patient died despite receiving intensive treatment. Autopsy confirmed Aspergillus hyphal invasion, corresponding to the bronchoscopic findings, highlighting a rare but diagnostically important airway manifestation of CAPA.

PMID:
42875205
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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