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Successful treatment of allergic bronchopulmonary aspergillosis using a combination of oral voriconazole and the bronchoscopic instillation of amphotericin B: A case report and literature review.

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Τίτλος: Successful treatment of allergic bronchopulmonary aspergillosis using a combination of oral voriconazole and the bronchoscopic instillation of amphotericin B: A case report and literature review.
Συγγραφείς: Wu H; Department of Respiratory and Critical Care Medicine, Zigong First People's Hospital, Zigong, Sichuan, China., Tian M, Chen Z, He X, Zeng Y, Wang L, Deng Z
Πηγή: Medicine [Medicine (Baltimore)] 2026 Aug 28; Vol. 105 (35), pp. e50224.
Τύπος έκδοσης: Journal Article; Case Reports; Review
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 2985248R Publication Model: Print Cited Medium: Internet ISSN: 1536-5964 (Electronic) Linking ISSN: 00257974 NLM ISO Abbreviation: Medicine (Baltimore) Subsets: MEDLINE
Imprint Name(s): Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
Ιατρικοί όροι (MeSH): Amphotericin B*/administration & dosage , Amphotericin B*/therapeutic use , Voriconazole*/administration & dosage , Voriconazole*/therapeutic use , Aspergillosis, Allergic Bronchopulmonary*/drug therapy , Aspergillosis, Allergic Bronchopulmonary*/diagnosis , Antifungal Agents*/administration & dosage , Antifungal Agents*/therapeutic use, Bronchoscopy/methods ; Lung Neoplasms/diagnosis ; Humans ; Female ; Middle Aged ; Administration, Oral ; Treatment Outcome ; Aspergillus fumigatus
Περίληψη: Rationale: Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disease that results from hypersensitivity reactions triggered in response to A fumigatus. To date, there have been few reports of ABPA patients exhibiting elevated serum carcinoembryonic antigen levels. Moreover, while systemic antifungal treatment often results in substantial side effects when administered to ABPA patients, there has been little published regarding bronchoscopic amphotericin B instillation as an alternative treatment strategy.
Patient Concerns: We describe an ABPA patient who was repeatedly misdiagnosed with lung cancer. This 60-year-old woman complained of a 5-year history of a recurrent cough with whitish viscous sputum that had recurred and worsened within the 2 days before presentation. This woman had visited hospitals many times during this interval, and pulmonary computed tomography scans had revealed an occupying lesion in the left upper lobe of her lung. This, coupled with her elevated serum carcinoembryonic antigen levels and other lung cancer markers, led to the misdiagnosis of lung cancer.
Diagnoses: As we found that she also exhibited elevated serum IgE and circulating eosinophil counts, and Aspergillus was detected through rapid on-site evaluation, we sent a further blood sample for fungal antigen-specific antibody testing. This approach revealed markedly elevated levels of A fumigatus-specific IgE, Aspergillus-specific IgG and IgM, leading to the confirmation of an ABPA diagnosis.
Interventions: The patient was administered inhaled budesonide together with antifungal therapy consisting of oral voriconazole and bronchoscopic amphotericin B instillation. She was additionally provided empiric antibiotic treatment to alleviate her cough and reduce phlegm production.
Outcomes: Her symptoms and the associated lung lesion improved significantly.
Lessons: Bronchoscopic amphotericin B instillation represents a safe and effective approach to treating ABPA, providing a means of increasing local drug concentrations while minimizing the potential for systemic adverse reactions.
(Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, LLC.)
Competing Interests: The authors have no conflicts of interest to declare.
References: Agarwal R, Muthu V, Sehgal IS, Dhooria S, Prasad KT, Aggarwal AN. Allergic bronchopulmonary aspergillosis. Clin Chest Med. 2022;43:99–125.
D’Andrea P, Tauro L, Qin S. Pulmonary inflammation is mediated by cytokines in covid-19. Int J Infect. 2024;8:62–7.
Zeng Y, Xue X, Cai H, et al. Clinical characteristics and prognosis of allergic bronchopulmonary aspergillosis: a retrospective cohort study. J Asthma Allergy. 2022;15:53–62.
Feng H, Lv P, Ren X, Dai H, Yang T. Misinterpretation of allergic bronchopulmonary aspergillosis/allergic bronchopulmonary mycosis due to diverse characteristics in different clinical stages. J Thorac Dis. 2019;11:4484–91.
Dhooria S, Sehgal IS, Muthu V, Agarwal R. Treatment of allergic bronchopulmonary aspergillosis: from evidence to practice. Future Microbiol. 2020;15:365–76.
Agarwal R, Sehgal IS, Dhooria S, et al. Allergic bronchopulmonary aspergillosis. Indian J Med Res. 2020;151:529–49.
Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al. Diagnosis and management of aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018;24(Suppl 1):e1–e38.
Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63:e1–e60.
Scardina T, Fawcett AJ, Patel SJ. Amphotericin-associated infusion-related reactions: a narrative review of pre-medications. Clin Ther. 2021;43:1689–704.
Suberviola B. Clinical safety of liposomal amphotericin B. Rev Iberoam Micol. 2021;38:56–60.
Saggini R, Pellegrino R. MAPK is implicated in sepsis, immunity, and inflammation. Int J Infect. 2024;8:100–4.
Agarwal R. Allergic bronchopulmonary aspergillosis. Chest. 2009;135:805–26.
Agarwal R, Khan A, Garg M, Aggarwal AN, Gupta D. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol. 2012;4:141–50.
Ward S, Heyneman L, Lee MJ, Leung AN, Hansell DM, Muller NL. Accuracy of CT in the diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients. AJR Am J Roentgenol. 1999;173:937–42.
Roboubi A, Audousset C, Frealle E, et al. Allergic bronchopulmonary aspergillosis: a multidisciplinary review. J Mycol Med. 2023;33:101392.
Tiew PY, Lim AYH, Keir HR, et al. High frequency of allergic bronchopulmonary aspergillosis in bronchiectasis-COPD overlap. Chest. 2022;161:40–53.
Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol. 2013;51:361–70.
Agarwal R. Burden and distinctive character of allergic bronchopulmonary aspergillosis in India. Mycopathologia. 2014;178:447–56.
Agarwal R, Muthu V, Sehgal IS, et al. Prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in adults with bronchial asthma: a systematic review of global data. J Allergy Clin Immunol Pract. 2023;11:1734–51.e3.
Agarwal R, Hazarika B, Gupta D, Aggarwal AN, Chakrabarti A, Jindal SK. Aspergillus hypersensitivity in patients with chronic obstructive pulmonary disease: COPD as a risk factor for ABPA? Med Mycol. 2010;48:988–94.
Jin J, Liu X, Sun Y. The prevalence of increased serum IgE and aspergillus sensitization in patients with COPD and their association with symptoms and lung function. Respir Res. 2014;15:130.
Muthu V, Prasad KT, Sehgal IS, Dhooria S, Aggarwal AN, Agarwal R. Obstructive lung diseases and allergic bronchopulmonary aspergillosis. Curr Opin Pulm Med. 2021;27:105–12.
Jat KR, Walia DK, Khairwa A. Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis. Cochrane Database Syst Rev. 2021;9:CD010288.
Maturu VN, Agarwal R. Prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in cystic fibrosis: systematic review and meta-analysis. Clin Exp Allergy. 2015;45:1765–78.
Anwar GA, McDonnell MJ, Worthy SA, et al. Phenotyping adults with non-cystic fibrosis bronchiectasis: a prospective observational cohort study. Respir Med. 2013;107:1001–7.
Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respir Med. 2007;101:1163–70.
Kim JH, Jin HJ, Nam YH, Hwang EK, Ye YM, Park HS. Clinical features of allergic bronchopulmonary aspergillosis in Korea. Allergy Asthma Immunol Res. 2012;4:305–8.
Oguma T, Taniguchi M, Shimoda T, et al. Allergic bronchopulmonary aspergillosis in Japan: a nationwide survey. Allergol Int. 2018;67:79–84.
Muthu V, Sehgal IS, Prasad KT, et al. Epidemiology and outcomes of allergic bronchopulmonary aspergillosis in the elderly. Mycoses. 2022;65:71–8.
Agarwal R, Gupta D, Aggarwal AN, Behera D, Jindal SK. Allergic bronchopulmonary aspergillosis: lessons from 126 patients attending a chest clinic in North India. Chest. 2006;130:442–8.
Noguchi T, Yamamoto K, Moriyama G, et al. Evaluation of serum levels of carcinoembryonic antigen in allergic bronchopulmonary aspergillosis. J Nippon Med Sch. 2013;80:404–9.
Yang Y, Gao Q, Jin Y, Qi M, Lu G, Li H. Eosinophils may serve as CEA-secreting cells for allergic bronchopulmonary aspergillosis (ABPA) patients. Sci Rep. 2021;11:4025.
Wang J, Tang Y, Li X, et al. Clinical relevance of elevated serum carcinoembryonic antigen in allergic bronchopulmonary aspergillosis/mycosis: a multicenter retrospective study. J Asthma Allergy. 2024;17:1313–23.
Rosenberg M, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1977;86:405–14.
Greenberger PA, Patterson R. Allergic bronchopulmonary aspergillosis and the evaluation of the patient with asthma. J Allergy Clin Immunol. 1988;81:646–50.
Stevens DA, Moss RB, Kurup VP, et al.; Participants in the Cystic Fibrosis Foundation Consensus Conference. Allergic bronchopulmonary aspergillosis in cystic fibrosis--state of the art: cystic fibrosis foundation consensus conference. Clin Infect Dis. 2003;37(Suppl 3):S225–264.
Knutsen AP, Bush RK, Demain JG, et al. Fungi and allergic lower respiratory tract diseases. J Allergy Clin Immunol. 2012;129:280–91; quiz 292.
Agarwal R, Chakrabarti A, Shah A, et al.; ABPA Complicating Asthma ISHAM Working Group. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43:850–73.
Muthu V, Sehgal IS, Prasad KT, et al. Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: a distinct subset of ABPA with a lesser risk of exacerbation. Med Mycol. 2020;58:260–3.
Okada N, Yamamoto Y, Oguma T, et al. Allergic bronchopulmonary aspergillosis with atopic, nonatopic, and sans asthma-factor analysis. Allergy. 2023;78:2933–43.
Asano K, Hebisawa A, Ishiguro T, et al.; Japan ABPM Research Program. New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation. J Allergy Clin Immunol. 2021;147:1261–8.e5.
Asthma Group of Chinese Thoracic Society. Expert consensus on the diagnosis and treatment of allergic bronchopulmonary aspergillosis (2022 update). Zhonghua Jie He He Hu Xi Za Zhi. 2022;45:1169–79.
Wang H, Ren T, Wang X, et al. Rapid on-site evaluation of touch imprints of biopsies improves the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy: a retrospective study. Jpn J Clin Oncol. 2021;51:622–9.
Kassirian S, Hinton SN, Iansavitchene A, et al. Effect of needle size on diagnosis of sarcoidosis with endobronchial ultrasound-guided transbronchial needle aspiration: systematic review and meta-analysis. Ann Am Thorac Soc. 2022;19:279–90.
Facciorusso A, Sunny SP, Del Prete V, Antonino M, Muscatiello N. Comparison between fine-needle biopsy and fine-needle aspiration for EUS-guided sampling of subepithelial lesions: a meta-analysis. Gastrointest Endosc. 2020;91:14–22.e2.
Wang H, Liu Y, Wang J, et al. Rapid on-site evaluation of touch imprints of medical thoracoscopy biopsy tissue for the management of pleural disease. Front Med (Lausanne). 2023;10:1196000.
Iliaz S, Caglayan B, Bulutay P, Armutlu A, Uzel I, Ozturk AB. Rapid on-site evaluation and final cytologic diagnoses correlation during endobronchial ultrasonography. J Bronchol Interv Pulmonol. 2022;29:191–7.
Xu CH, Wang JW, Wang W, et al. The diagnosis value of endobronchial ultrasound transbronchial lung biopsy combined with rapid on-site evaluation in peripheral lung cancer. Clin Respir J. 2020;14:447–52.
Wang H, Wang L, Luo Z, et al. Performance of rapid on-site evaluation of touch imprints of lung tissue biopsies for the diagnosis of pulmonary cryptococcosis in patients without HIV infection. Mycoses. 2022;65:635–42.
Yan P, Hao QX, Song LC, et al. The value of microbiology rapid on-site evaluation of sepsis caused by pulmonary infection. Eur Rev Med Pharmacol Sci. 2023;27:5862–8.
Chen H, Yin Y, Gao H, et al. Clinical utility of in-house metagenomic next-generation sequencing for the diagnosis of lower respiratory tract infections and analysis of the host immune response. Clin Infect Dis. 2020;71:S416–26.
Huang J, Jiang E, Yang D, et al. Metagenomic next-generation sequencing versus traditional pathogen detection in the diagnosis of peripheral pulmonary infectious lesions. Infect Drug Resist. 2020;13:567–76.
Agarwal R, Aggarwal AN, Dhooria S, et al. A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J. 2016;47:490–8.
Maijers I, Kearns N, Harper J, Weatherall M, Beasley R. Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma. Eur Respir J. 2020;55:1901147.
Agarwal R, Muthu V, Sehgal IS, et al. A randomised trial of prednisolone versus prednisolone and itraconazole in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J. 2022;59:2101787.
Johnson LB, Kauffman CA. Voriconazole: a new triazole antifungal agent. Clin Infect Dis. 2003;36:630–7.
Douglas AP, Smibert OC, Bajel A, et al.; Australasian Antifungal Guidelines Steering Committee. Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021. Intern Med J. 2021;51(Suppl 7):143–76.
Muthu V, Dhooria S, Sehgal IS, et al. Nebulized amphotericin B for preventing exacerbations in allergic bronchopulmonary aspergillosis: a systematic review and meta-analysis. Pulm Pharmacol Ther. 2023;81:102226.
Yang L, Yang C, Wan N, et al. Bronchoscopic instillation of amphotericin B is a safe and effective measure to treat pulmonary mycosis. Front Pharmacol. 2023;14:1167475.
Wang X, Mohammad IS, Fan L, et al. Delivery strategies of amphotericin B for invasive fungal infections. Acta Pharm Sin B. 2021;11:2585–604.
Contributed Indexing: Keywords: allergic bronchopulmonary aspergillosis; amphotericin B; bronchoscopic instillation; carcinoembryonic antigen; diagnostic criteria; voriconazole
Substance Nomenclature: 7XU7A7DROE (Amphotericin B)
JFU09I87TR (Voriconazole)
0 (Antifungal Agents)
Entry Date(s): Date Created: 20260901 Date Completed: 20260901 Latest Revision: 20261014
Update Code: 20261014
PubMed Central ID: PMC13529180
DOI: 10.1097/MD.0000000000050224
PMID: 42675710
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1536-5964
DOI:10.1097/MD.0000000000050224