A 44-year-old male with a history of HIV infection with AIDS and Burkitt B-cell lymphoma was admitted to the ICU due to respiratory failure with neutropenia (80 cells/µl). Fibrobronchoscopy revealed extensive whitish-black exophytic lesions (Fig. 1, red asterisk) strongly suggestive of hyphae (Fig. 2, blue asterisks) lining the entire trachea (Video 1), carina and main bronchi (Video 2). Combination antifungal therapy was started with amphotericin B and caspofungin. Bronchoalveolar lavage confirmed the diagnosis of infection due to Aspergillus fumigatus. The mycosis presented a poor course, with mucosal necrosis and progression towards tracheoesophageal fistula and tracheal rupture that resulted in the death of the patient.

Figure 1

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Figure 2

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