Abed Alhaleem Mohammad, Hussain Muhammed H, Ahmed Ahmed, Ahmed Wafa, Gunaseelan Luxhman, Easow Andrew
Internal Medicine, Corewell Health Dearborn Hospital, Dearborn, USA.
Internal Medicine, Wayne State University, Detroit, USA.
Cureus. 2025 Jun 16;17(6):e86114. doi: 10.7759/cureus.86114. eCollection 2025 Jun.
Bronchiectasis is a chronic respiratory disorder that predisposes patients to recurrent infections and airway inflammation. The coexistence of allergic bronchopulmonary aspergillosis (ABPA) and non-tuberculous mycobacterial (NTM) infection in the setting of bronchiectasis presents a significant diagnostic and therapeutic challenge. This case report describes a 57-year-old male with a history of asthma and bronchiectasis who developed concurrent ABPA and infection. Management was complicated by the immunosuppressive requirements of ABPA treatment, which posed a risk for exacerbating the NTM infection. The patient was initiated on itraconazole monotherapy with therapeutic monitoring, but subtherapeutic drug levels and treatment discontinuation due to logistical barriers limited its effectiveness. This case underscores the importance of individualized treatment strategies, close multidisciplinary collaboration, and the need for consistent follow-up in patients with overlapping pulmonary conditions. It highlights the critical balance between immunosuppression and infection control in complex bronchiectasis cases, as well as the systemic challenges that can disrupt optimal care delivery.
支气管扩张是一种慢性呼吸系统疾病，使患者易发生反复感染和气道炎症。在支气管扩张的情况下，变应性支气管肺曲霉病（ABPA）和非结核分枝杆菌（NTM）感染并存带来了重大的诊断和治疗挑战。本病例报告描述了一名57岁男性，有哮喘和支气管扩张病史，并发了ABPA和NTM感染。ABPA治疗所需的免疫抑制导致管理复杂化，这有加重NTM感染的风险。患者开始接受伊曲康唑单药治疗并进行治疗监测，但由于后勤障碍导致药物水平未达治疗标准且治疗中断，限制了其有效性。本病例强调了个体化治疗策略、密切的多学科协作以及对重叠肺部疾病患者进行持续随访的必要性。它突出了复杂支气管扩张病例中免疫抑制与感染控制之间的关键平衡，以及可能扰乱最佳治疗提供的系统性挑战。
