Acute Respiratory Distress Syndrome Due to COVID-19-Associated Pulmonary Aspergillosis with Rare Extensive Tracheobronchial Pseudomembranous Involvement: A Case Report

COVID-19-associated pulmonary aspergillosis (CAPA) significantly exacerbates the clinical outcomes of COVID-19 patients, contributing to heightened mortality. Aspergillus tracheobronchitis, a manifestation of invasive pulmonary aspergillosis, specifically involves the tracheobronchial tree. According to the 2020 European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria, airway biopsy via bronchoscopy is the definitive method for CAPA diagnosis, underscoring its critical role in the management of COVID-19 patients. This case report describes an elderly male patient with COVID-19 who presented with extensive pseudomembranous involvement of the tracheobronchial tree, identified through bronchoscopy. The pseudomembrane, spanning from the glottis to the bronchi and characterized by its yellow-white translucency, was removed. Subsequent pathological examination and next-generation sequencing confirmed an Aspergillus infection. Despite the initiation of antifungal therapy, the patient’s condition deteriorated, leading to his death. © The Author(s) 2025.