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

Overview

Journal Mycopathologia

Specialties Microbiology
Pharmacology

Date 2015 Jun 6

PMID 26045286

Citations 11

Authors

Venkata Nagarjuna Maturu

Ritesh Agarwal

Affiliations

Soon will be listed here.

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.

Citing Articles

Combined allergic bronchopulmonary mycosis and eosinophilic granulomatosis with polyangiitis: A case report and literature review.

Cui N, Wang J, Shao Y, Zhao J, Cheng Z Respir Med Case Rep. 2024; 48:102012.

PMID: 38545557 PMC: 10966086. DOI: 10.1016/j.rmcr.2024.102012.

Subacute invasive pulmonary aspergillosis in a nondiabetic immunocompetent female suffering from allergic broncho pulmonary aspergillosis.

Kumar S, Singh D, Ansari S, Hada V J Family Med Prim Care. 2024; 12(11):2956-2958.

PMID: 38186818 PMC: 10771185. DOI: 10.4103/jfmpc.jfmpc_980_23.

Coinfection with Hypervirulent and in a Critically Ill Patient with Overlap Syndrome: A Case Report.

Xu Y, Wang Y, Wu J, Zhao X, Huang G, Fang J Infect Drug Resist. 2023; 15:7823-7830.

PMID: 36600954 PMC: 9807123. DOI: 10.2147/IDR.S394004.

Characteristics of the Computed Tomography Imaging Findings in 72 Patients with Airway-Invasive Pulmonary Aspergillosis.

Wu J, Zhang T, Pan J, Zhang Q, Lin X, Chang L Med Sci Monit. 2021; 27:e931162.

PMID: 34453030 PMC: 8409142. DOI: 10.12659/MSM.931162.

Allergic bronchopulmonary aspergillosis.

Agarwal R, Sehgal I, Dhooria S, Muthu V, Prasad K, Bal A Indian J Med Res. 2020; 151(6):529-549.

PMID: 32719226 PMC: 7602921. DOI: 10.4103/ijmr.IJMR_1187_19.

References

Starke I, KEAL E . Cerebral aspergilloma in a patient with allergic bronchopulmonary aspergillosis. Br J Dis Chest. 1980; 74(3):301-5. DOI: 10.1016/0007-0971(80)90061-3. View

De Pauw B, Walsh T, Donnelly J, Stevens D, Edwards J, Calandra T . Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group.... Clin Infect Dis. 2008; 46(12):1813-21. PMC: 2671227. DOI: 10.1086/588660. View

Denning D, Pleuvry A, Cole D . Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol. 2012; 51(4):361-70. DOI: 10.3109/13693786.2012.738312. View

Soubani A, Chandrasekar P . The clinical spectrum of pulmonary aspergillosis. Chest. 2002; 121(6):1988-99. DOI: 10.1378/chest.121.6.1988. View

Agarwal R, Aggarwal A, Garg M, Saikia B, Gupta D, Chakrabarti A . Allergic bronchopulmonary aspergillosis with aspergilloma: an immunologically severe disease with poor outcome. Mycopathologia. 2012; 174(3):193-201. DOI: 10.1007/s11046-012-9535-x. View

Henderson A . Allergic aspergillosis: review of 32 cases. Thorax. 1968; 23(5):501-12. PMC: 471837. DOI: 10.1136/thx.23.5.501. View

Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis J, Guleria R . Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013; 43(8):850-73. DOI: 10.1111/cea.12141. View

Chung Y, Kraut J, Stone A, VALAITIS J . Disseminated aspergillosis in a patient with cystic fibrosis and allergic bronchopulmonary aspergillosis. Pediatr Pulmonol. 1994; 17(2):131-4. DOI: 10.1002/ppul.1950170210. View

Gupta K, Das A, Joshi K, Singh N, Aggarwal R, Prakash M . Aspergillus endocarditis in a known case of allergic bronchopulmonary aspergillosis: an autopsy report. Cardiovasc Pathol. 2009; 19(4):e137-9. DOI: 10.1016/j.carpath.2008.12.002. View

10.

Lebrun-Vignes B, Archer V, Diquet B, Levron J, Chosidow O, Puech A . Effect of itraconazole on the pharmacokinetics of prednisolone and methylprednisolone and cortisol secretion in healthy subjects. Br J Clin Pharmacol. 2001; 51(5):443-50. PMC: 2014476. DOI: 10.1046/j.1365-2125.2001.01372.x. View

11.

Agarwal R, Denning D, Chakrabarti A . Estimation of the burden of chronic and allergic pulmonary aspergillosis in India. PLoS One. 2014; 9(12):e114745. PMC: 4257713. DOI: 10.1371/journal.pone.0114745. View

12.

Patterson K, Strek M . Diagnosis and treatment of pulmonary aspergillosis syndromes. Chest. 2014; 146(5):1358-1368. DOI: 10.1378/chest.14-0917. View

13.

Linthoudt H, Van Raemdonck D, Lerut T, Demedts M, Verleden G . The association of itraconazole and methylprednisolone may give rise to important steroid-related side effects. J Heart Lung Transplant. 1996; 15(11):1165. View

14.

Kousha M, Tadi R, Soubani A . Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011; 20(121):156-74. PMC: 9584108. DOI: 10.1183/09059180.00001011. View

15.

Varis T, Kaukonen K, Kivisto K, Neuvonen P . Plasma concentrations and effects of oral methylprednisolone are considerably increased by itraconazole. Clin Pharmacol Ther. 1998; 64(4):363-8. DOI: 10.1016/S0009-9236(98)90066-2. View

16.

Bodey G, Glann A . Central nervous system aspergillosis following steroidal therapy for allergic bronchopulmonary aspergillosis. Chest. 1993; 103(1):299-301. DOI: 10.1378/chest.103.1.299. View

17.

Riley D, Mackenzie J, Uhlman W, Edelman N . Allergic bronchopulmonary aspergillosis: evidence of limited tissue invasion. Am Rev Respir Dis. 1975; 111(2):232-6. DOI: 10.1164/arrd.1975.111.2.232. View

18.

Agarwal R . Allergic bronchopulmonary aspergillosis. Chest. 2009; 135(3):805-826. DOI: 10.1378/chest.08-2586. View

19.

Ganassini A, Cazzadori A . Invasive pulmonary aspergillosis complicating allergic bronchopulmonary aspergillosis. Respir Med. 1995; 89(2):143-5. DOI: 10.1016/0954-6111(95)90198-1. View

20.

Aquino S, Kee S, Warnock M, Gamsu G . Pulmonary aspergillosis: imaging findings with pathologic correlation. AJR Am J Roentgenol. 1994; 163(4):811-5. DOI: 10.2214/ajr.163.4.8092014. View