Mixed Types Of Pulmonary Aspergillosis:one Case Report And Literature Review

Objective:Combined with clinical data of mixed types of pulmonary aspergillosis,to explore the clinical feature,diagnosis,treatment of mixed types of pulmonary aspergillosis,and improve the awareness of mixed types of pulmonary aspergillosis.Methods:We retrospectively analyzed the clinical feature,laboratory examinations,CT image,etiology,diagnosis,treatment and follow-up data of a asthmatic patient who was diagnosed with mixed types of pulmonary aspergillosis in our hospital,and reviewed the relevant literature to discuss the characteristics and treatment of mixed types of pulmonary aspergillosis.Results:(1)A young female asthmatic patient in our hospital who was in stable condition after the standardized threatment of asthma.However,her symptoms were not under control in the past 1 year.The main manifestations were wheezing,cough and purulent yellow sputum.Mucus plugs could be seen under fiber bronchoscope,lesions in both lung tended to vary,shift,also with central bronchiectasis.Her peripheral blood eosinophils and serum total IgE was significantly increased,skin sensitivity test was positive to aspergillus,serum CEA was significantly rising but no tumor was found by PET/CT and ultrasound examinations.She was diagnosed with asthma combined allergic bronchopulmonary aspergillosis,and her condition was improved by taking glucocorticoid with antifungal drug.After a period of time,her clinical symptoms repeated again,lesions in both lungs increased,invasive pulmonary aspergillosis(ABPA overlap IPA)was subsequently diagnosed,antifungal agents and inhalation of Symbicort were given to her with effectiveness.Reexamination showed a decrease of serum CEA and lesions of both lungs resolved.Finally,she was given long-term oral prednisone acetate combined with inhalation of Symbicort,prednisone acetate gradually decreased to withdrawal.In follow-up,she was in stable condition,improved lung function.(2)Literature review results: A total of 39 cases of MTPA were collected,ABPA overlap IPA was the most,a total of 15 cases(38.5%),14 cases had a history of asthma,and 14 cases had long-term treatment with corticosteroids.Major symptoms included cough and sputum-coughing(93.3%),dyspnea(100.0%),fever(73.3%).Chest CT showed nodules,high-density patch(100.0%),bronchiectasis(56.2%)and cavities(43.7%).9 cases(60.0%)with condition improved,6 cases(40.0%)died,treatments included corticosteroids,antifungal drugs and combination therapy.12 cases(30.8%)of ABPA overlap aspergilloma,8 cases had a history of asthma.Major symptoms include cough and sputum-coughing(91.7%),dyspnea(83.3%),hemoptysis(75%).Chest CT showed aspergilloma(100.0%),cavity(83.3%),bronchiectasis(66.7%).All the cases(100.0%)with condition improved,treatments included corticosteroids,antifungal drugs,lobectomy and combination therapy.10 cases(25.6%)of aspergilloma overlap IPA,underlying disease included sarcoidosis,HIV,tuberculosis,malignant tumor.Major symptoms included hemoptysis(70.0%),cough and sputum-coughing(60.0%),fever(50.0%).Chest CT showed pulmonary nodules,high-density patch(70.0%),cavity(100.0%),and aspergilloma(100.0%).5 cases(50.0%)with condition improved,5 cases(50.0%)died.Treatments included corticosteroids,antifungal drugs,lobectomy,bronchial artery embolization and combition therapy.2 cases(5.1%)of ABPA combined with aspergilloma and IPA,1cases had a history of asthma and long-term treatment with corticosteroids.Major symptoms included cough and sputum-coughing,dyspnea,fever,hemoptysis.Chest CT showed cavity,aspergilloma and bronchiectasis.Anti-fungal and corticosteroids was effective in 1 patient,while corticosteroids alone was fatal in 1 patient.Conclusions:1 ABPA overlap other types of pulmonary aspergillosis was the most common type of MTPA and aspergillus fumigatus might be the most common pathogenic aspergillus.2 Asthma was common in MTPA patients who overlap ABPA and the complexity of these patients had increased.3 Glucocorticoid might be one of the major risk factors of ABPA overlap IPA.4 MTPA patients who overlap IPA had a high death rate.