Simultaneous diagnosis of allergic bronchopulmonary aspergillosis and Mycobacterium avium complex lung disease

Naoki Takasaka; Kentaro Chida; Takeo Ishikawa; Kazuyoshi Kuwano

doi:10.1136/bcr-2023-255845

Simultaneous diagnosis of allergic bronchopulmonary aspergillosis and Mycobacterium avium complex lung disease

BMJ Case Rep. 2023 Sep 26;16(9):e255845. doi: 10.1136/bcr-2023-255845.

Authors

Naoki Takasaka¹, Kentaro Chida², Takeo Ishikawa², Kazuyoshi Kuwano³

Affiliations

¹ Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, Komae, Tokyo, Japan ntakasaka@jikei.ac.jp.
² Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, Komae, Tokyo, Japan.
³ Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) and Mycobacterium avium complex lung disease (MAC-LD) often coexist because bronchiectasis, caused by ABPA or MAC, might be an important predisposing factor for both conditions. Here, we describe a man with asthma symptoms who had centrilobular small nodules and mucoid impaction on chest CT. We diagnosed the patient with simultaneous ABPA and MAC-LD on the basis of bronchoscopy findings. Itraconazole monotherapy led to substantial clinical improvement, avoiding the adverse effects of systemic corticosteroids. Sputum culture conversion of MAC was achieved after switching from itraconazole monotherapy to combination therapy comprising clarithromycin, rifampicin and ethambutol. ABPA recurred but was controlled by reinitiation of itraconazole. Overall, corticosteroid management was avoided for 38 months. Itraconazole monotherapy may be selected as initial treatment for ABPA with chronic infection, including MAC.

Keywords: Asthma; Bronchitis; Infections; Pneumonia (infectious disease).

Publication types

Case Reports

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Aspergillosis, Allergic Bronchopulmonary* / complications
Aspergillosis, Allergic Bronchopulmonary* / diagnosis
Aspergillosis, Allergic Bronchopulmonary* / drug therapy
Humans
Itraconazole / therapeutic use
Lung Diseases* / complications
Male
Mycobacterium avium Complex
Mycobacterium avium-intracellulare Infection* / complications
Mycobacterium avium-intracellulare Infection* / diagnosis
Mycobacterium avium-intracellulare Infection* / drug therapy

Substances

Itraconazole
Adrenal Cortex Hormones