Unusual coexistence: Allergic bronchopulmonary aspergillosis and pulmonary tuberculosis- A rare case report

Abstract

: Allergic Bronchopulmonary Aspergillosis (ABPA) is an allergic hypersensitivity reaction to the ubiquitous fungus Aspergillus that can cause inflammation and damage to the respiratory system. This condition predominantly occurs in individuals with long-standing airway disease, such as bronchial asthma or cystic fibrosis. While Acid-fast bacilli Mycobacterium tuberculosis causes tuberculosis (TB). ABPA and TB can coexist in the same patient. The coexistence of these two conditions can make the diagnosis and treatment more challenging. This is because some of the symptoms of ABPA, such as cough and wheezing, can be similar to those of TB, and both conditions can cause lung damage. A 21-year young male was admitted with a six-month history of low-grade fever, cough with expectoration, atypical chest pain, and progressive breathlessness. On examination, the patient had bilateral diffuse rhonchi with coarse crepitation, and his chest X-ray showed bilateral heterogeneous opacities with cavities in the left upper and middle zone. Further evaluation revealed a total serum IgE of 3074 IU/L (Normal <100) and elevated levels of Aspergillus fumigatus-specific IgE and IgG. A high-resolution CT of the thorax revealed bilateral upper lobes with tree-in-bud opacities and centrilobular nodules, leading to a diagnosis of ABPA. A sputum sample was sent for an AFB smear, which was positive.Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus that most commonly affects people who have bronchial asthma or cystic fibrosis. However, diagnosis can be challenging as patients may not respond to standard treatment, and the symptoms can overlap with those of other respiratory diseases. Therefore, clinicians need to maintain a high index of suspicion for ABPA in at-risk patients and consider appropriate screening tests.This case highlights the rare co-existence of active pulmonary TB and ABPA, which can make diagnosis and treatment challenging. However, with appropriate management, including anti-tubercular treatment and corticosteroid therapy, the patient showed marked improvement in his condition. Clinicians should consider the possibility of multiple comorbidities in patients presenting with respiratory symptoms, and appropriate evaluation and management should be undertaken to achieve optimal outcomes.