Coexistence of Asymptomatic Allergic Bronchopulmonary Aspergillosis and Active Pulmonary Tuberculosis: Case Report.

Abstract

We present a rare case of asymptomatic allergic bronchopulmonary aspergillosis (ABPA) concurrent with active pulmonary tuberculosis. Allergic bronchopulmonary aspergillosis is an immunological pulmonary disorder characterized by hypersensitivity to Aspergillus fumigatus, while pulmonary tuberculosis (PTB) is a complex infection caused by Mycobacterium tuberculosis (MTB). The association between pulmonary tuberculosis infections and Aspergillus infections remains a fascinating area of inquiry. A 26-year-old female patient exhibited no symptoms. However, her initial chest computed tomography revealed bronchiectasis with high-attenuation mucus plugs in the upper lobes, peripheral lung atelectasis, and a tree-in-bud pattern. To obtain a clear diagnosis, she visited multiple hospitals and incurred substantial time and financial costs. Active tuberculosis was initially confirmed using specialized detection methods, including metagenomic next-generation sequencing and Xpert MTB/RIF analysis of bronchoalveolar lavage fluid. Subsequent pathological biopsy and Aspergillus-specific antibody tests further confirmed the diagnosis of allergic bronchopulmonary aspergillosis combined with active tuberculosis. Following twelve months of antituberculosis therapy, an avoidable surgery, and three months of oral glucocorticoid treatment, the patient's lung lesions showed significant resolution. This case provides valuable insights into the clinical diagnosis and management of these two distinct infectious diseases.