Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, Komae, Tokyo, Japan
Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, Komae, Tokyo, Japan.
BMJ Case Rep. 2023 Sep 26;16(9):e255845. doi: 10.1136/bcr-2023-255845.
Allergic bronchopulmonary aspergillosis (ABPA) and 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.
变应性支气管肺曲霉病（ABPA）和复杂肺部疾病（MAC-LD）常同时存在，因为 ABPA 或 MAC 引起的支气管扩张可能是这两种疾病的重要诱发因素。在此，我们描述了一位有哮喘症状的患者，其胸部 CT 显示存在中心性小叶小结节和黏液嵌塞。根据支气管镜检查结果，我们诊断患者同时患有 ABPA 和 MAC-LD。伊曲康唑单药治疗显著改善了临床症状，避免了全身皮质类固醇的不良反应。从伊曲康唑单药治疗转换为克拉霉素、利福平、乙胺丁醇联合治疗后，MAC 的痰培养转为阴性。ABPA 复发，但通过重新开始伊曲康唑治疗得到控制。总的来说，患者 38 个月未使用皮质类固醇治疗。伊曲康唑单药治疗可能被选为伴有慢性感染（包括 MAC）的 ABPA 的初始治疗。
