Recurrence of allergic bronchopulmonary aspergillosis after adjunctive surgery for aspergilloma: a case report with long-term follow-up

Abstract

BackgroundCoexistence of aspergilloma and allergic bronchopulmonary aspergillosis (ABPA) has rarely been reported. Although the treatment for ABPA includes administration of corticosteroids and antifungal agents, little is known about the treatment for coexisting aspergilloma and ABPA. Furthermore, the impact of surgical resection for aspergilloma on ABPA is not fully understood. Here, we present an interesting case of recurrent ABPA with long-term follow-up after surgical resection of aspergilloma.Case presentationA 53-year-old man with a medical history of tuberculosis was referred to our hospital with cough and dyspnea. Imaging revealed multiple cavitary lesions in the right upper lobe of the lung, with a fungus ball and mucoid impaction. The eosinophil count, total serum immunoglobulin E (IgE), and Aspergillus-specific IgE levels were elevated. Specimens collected on bronchoscopy revealed fungal filaments compatible with Aspergillus species. Based on these findings, a diagnosis of ABPA with concomitant aspergilloma was made. Although treatment with corticosteroids and antifungal agents was administered, the patient’s respiratory symptoms persisted. Therefore, he underwent lobectomy of the right upper lobe, which resulted in a stable condition without the need for medication. Twenty-three months after discontinuation of medical treatment, his respiratory symptoms gradually worsened with a recurrence of elevated eosinophil count and total serum IgE. Imaging revealed recurrent bronchiectasis and cavities with mucoid impaction in the right lower lobe, suggesting relapse of aspergilloma and ABPA. Corticosteroids and antifungal agents were re-administered; aspergilloma improved slightly over a 5-year period, and ABPA remained well controlled with low-dose prednisolone (5 mg/day).ConclusionsWe describe the long-term follow-up outcomes of a patient with concomitant ABPA and aspergilloma, who underwent surgical resection for aspergilloma. Physicians should carefully monitor patients with coexisting ABPA and aspergilloma, as the condition may relapse after remission, even despite surgical resection for aspergilloma. Additionally, surgical resection for aspergilloma could result in resolution of ABPA.

Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006‐2016)

“…Eosinophilic granulomatosis with vasculitis (previously referred to as Churg‐Strauss syndrome) is a very rare disorder characterized by nodules surrounding blood vessels that can be found in association with severe asthma, and it does not resemble the EG described here. The only syndrome in humans with a presentation somewhat similar to that of EG in dogs described here is aspergilloma, a noninvasive intra‐airway fungal infection treated with itraconazole or surgical excision . It is often found in association with bronchiectasis and also can be found with ABPA .…”

“…The only syndrome in humans with a presentation somewhat similar to that of EG in dogs described here is aspergilloma, a noninvasive intra-airway fungal infection treated with itraconazole or surgical excision. 17,18 It is often found in association with bronchiectasis and also can be found with ABPA. 19,20 However, in our study, all dogs with EG tested for fungal infection were negative on culture or histopathology, indicating a lack of similarity to this condition in humans.…”

Features of the simultaneous course of pulmonary aspergillosis and tuberculosis on the background of type 1 diabetes mellitus (clinical case)

“…A. Maertens et al [8] indicate a high frequency of negative cultural results, which significantly complicates the differential diagnosis. Also, identification of galactomannan antigen in serum and bronchoalveolar lavage samples [12] and Aspergillusspecific IgE, is recommended for diagnosis of aspergillosis [13]. And for the diagnosis of endobronchial aspergilloma, which is diagnosed in various diseases (cancer with metastases, TB, bronchiolitis, etc.…”

“…Horiuchi K. et al [13] observed a clinical case of simultaneous course of allergic bronchiolegenic aspergillosis and aspergilloma in a patient, who had had TB in the past. Despite massive hormone and antifungal therapy, the patient continued to have respiratory symptoms, which were the reason of lobectomy of the upper lobe of the right lung, where aspergilloma was localized.…”