Acute Invasive Pulmonary Aspergillosis Complicating Allergic Bronchopulmonary Aspergillosis: Case Report and Systematic Review

Abstract

Aspergillus fumigatus can cause a variety of pulmonary syndromes including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis and invasive pulmonary aspergillosis (IPA). Occurrence of IPA and ABPA in the same patient is rare as the risk factors for ABPA and IPA are different. We describe a 45-year-old male with ABPA treated with oral methylprednisolone and itraconazole, who developed acute respiratory failure secondary to IPA, a month later. The patient subsequently improved after systemic antifungal therapy. Presumably, itraconazole by inhibiting CYP3A4 enzyme caused an increase in plasma methylprednisolone levels. This probably led to a profound immunosuppressed state, which predisposed to the development of IPA. We performed a systematic review and identified nine cases of IPA following ABPA. The disease course is fulminant, and only three of the nine patients survived. Physicians treating ABPA patients should be aware of this potentially fatal overlap. Clinical suspicion and early diagnosis are crucial to improve the patient outcomes.

Treatment of allergic bronchopulmonary mycosis: Experience of 55 patients with 124 relapses—A descriptive study

“…In fact, one male patient with ABPM in our hospital developed chronic progressive pulmonary aspergillosis during his clinical course. Other patients who have developed invasive pulmonary aspergillosis and chronic progressive pulmonary aspergillosis under SCSs have also been reported . Nineteen of our 25 patients who did not receive SCSs as an initial treatment improved, and we found that each treatment option without SCSs was effective at various different frequencies.…”

Spontaneous Regression of Allergic Bronchopulmonary Mycosis Due to <i>Curvularia lunata</i>

“…Based on the results of antifungal susceptibility testing, we expected several anti-fungal agents to be ineffective against the pathogen. It has been reported that ABPA can progress into invasive pulmonary aspergillosis ( 15 ). Sometimes corticosteroid therapy results in compromised immunity and fungal dissemination, as a result, we determined that anti-fungal therapy might not be effective in this case.…”

Tombs of Aspergillus: A missed cause of recurrent respiratory infections in allergic bronchopulmonary aspergillosis

“…Nine cases of invasive aspergillosis have been reported in patients with ABPA. [ 5 ] A probable increase in serum steroid levels secondary to cytochrome enzyme inhibition consequent to itraconazole use has been postulated.…”