Dynamic Bronchoscopic Evolution of a Cobblestone-like Appearance in COVID-19-associated Pulmonary Aspergillosis: A Case Report
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.
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BibTeX
@article{ishida2026dynamic,
title = {{Dynamic Bronchoscopic Evolution of a Cobblestone-like Appearance in COVID-19-associated Pulmonary Aspergillosis: A Case Report}},
author = {Toshihide Ishida and Nobuhiro Fujishima and Yoshio Satonaga and Marimu Yamanaka and Shota Omori and Ryuichi Takenaka and Ryuzo Abe and Kazuhiro Kawamura and Tsutomu Daa and Kosaku Komiya},
journal = {Internal Medicine},
year = {2026},
month = oct,
doi = {10.2169/internalmedicine.7958-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7958-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Dynamic Bronchoscopic Evolution of a Cobblestone-like Appearance in COVID-19-associated Pulmonary Aspergillosis: A Case Report
AU - Toshihide Ishida
AU - Nobuhiro Fujishima
AU - Yoshio Satonaga
AU - Marimu Yamanaka
AU - Shota Omori
AU - Ryuichi Takenaka
AU - Ryuzo Abe
AU - Kazuhiro Kawamura
AU - Tsutomu Daa
AU - Kosaku Komiya
PY - 2026
DA - 2026/10/15
JO - Internal Medicine
DO - 10.2169/internalmedicine.7958-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7958-26/_article
AB - 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.
SN - 1349-7235
SN - 0918-2918
ER -