Invasive aspergillosis is recognized as one of the most significant opportunistic infections after liver transplantation. Diagnosis of invasive aspergillosis in transplant recipients has been proven to be challenging, and optimal approach to the treatment of invasive aspergillosis is still controversial. We here present an unusual case of Aspergillus tracheobronchitis in the setting of liver transplantation. A 47-year-old female patient with persistent dry cough after liver transplantation developed respiratory insufficiency and was readmitted to the intensive care unit 55 days after liver transplantation. A CT scan revealed subtotal tracheal stenosis; bronchoscopy was performed, and extended white mucus coverings causative of the tracheal stenosis were removed. Microbiological assessment isolated Aspergillus fumigatus. The diagnosis was obstructive Aspergillus tracheobronchitis. The patient was started on a treatment of voriconazole 200？mg orally twice daily, adjusted to a trough level of 1–4？mg/L. For further airway management, a tracheal stent had to be implanted. The patient is alive and well 28 months after liver transplantation. Invasive aspergillosis should be considered a possible etiology in liver transplant patients presenting with unspecific symptoms such as persistent dry cough. Optimal strategies for improved and early diagnosis as well as prophylaxis need to be defined. 1. Introduction Invasive aspergillosis is one of the most significant opportunistic infections in solid-organ transplant recipients, and its diagnosis carries a high mortality rate [1]. Early diagnosis of invasive aspergillosis has been proven to be challenging, and the optimal approach to the treatment of invasive aspergillosis is still controversial. Aspergillus tracheobronchitis is a rare but severe form of invasive pulmonary aspergillosis in which the infection is entirely or predominantly confined to the tracheobronchial tree. Up to now, approximately 150 cases have been published in the English literature since 1985 [2]. Approximately 75% of patients with Aspergillus tracheobronchitis are immunocompromised. Of the reported cases, approximately 45% were solid-organ transplant recipients with a median time between transplantation and symptom onset of three months. Initial symptoms are generally deceptively mild. Patients often present with nonspecific respiratory symptoms for example, cough, dyspnea, stridor, or wheezing, and radiographic images frequently reveal no relevant findings. Delay of diagnosis and delayed initiation of targeted treatment remain critical for
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