[Late diagnosis of allergic pulmonary aspergillosis in a patient with post-tuberculosis pulmonary sequelae: a fatal case].

Abstract

Introduction: Allergic pulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus antigens. Its diagnosis can be delayed when it overlaps with other pulmonary conditions. We present the case of a patient with a history of childhood asthma and post-tuberculosis pulmonary sequelae, treated for years as severe asthma without improvement. ABPA was confirmed, but the late diagnosis limited therapeutic options, resulting in a fatal outcome.

Case report: A 61-year-old woman with a history of childhood asthma, hypertension, sleep apnea, and chronic cor pulmonale presented with pulmonary tuberculosis in 2000, which resolved after treatment, leaving sequelae such as bronchiectasis and oxygen dependence. She presented with persistent dyspnea and frequent exacerbations, with no improvement with treatment for severe asthma. Paraclinical tests: total IgE 2321 IU/mL, eosinophilia 908.4. Skin tests and specific IgG/IgE for Aspergillus fumigatus were positive. ABPA was diagnosed according to the International Society of Human and Animal Mycology (ISHAM) criteria. The patient was started on itraconazole and steroids. However, he developed massive hemoptysis, septic shock, and died in March 2025.

Conclusion: Allergic bronchopulmonary aspergillosis is an immunologically mediated disease. It occurs in patients with a history of asthma or cystic fibrosis. In susceptible individuals, Aspergillus produces an exaggerated immune response. In this case, the history of tuberculosis and bronchiectasis delayed diagnosis, resulting in delayed management and fatal complications. This scenario underscores the need for a high index of suspicion for ABPA in patients with bronchiectasis, asthma, and cystic fibrosis with refractory respiratory symptoms. Early diagnosis and timely treatment can improve the prognosis and reduce potentially fatal complications.