A case report of aspergillosis accompanied by saccular bronchodilation after bronchial thermoplasty in a 19-year-old wom
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CASE REPORT
A case report of aspergillosis accompanied by saccular bronchodilation after bronchial thermoplasty in a 19‑year‑old woman Shinji Sasada1* , Kenshiro Ohmura2, Tomoyo Oguri1,3, Yutaro Fujimoto1, Saori Murata1, Yumi Tsuchiya1, Kota Ishioka1, Saeko Takahashi1, Morio Nakamura1 and Masahiro Kaji2
Abstract Background: Fungal infections are rarely reported as a complication of bronchial thermoplasty (BT) in patients without immunosuppressive comorbidity. Case presentation: A 19-year-old woman college student was admitted to our hospital owing to uncontrolled severe asthma despite using the maximum dose of steroid inhalation. She experienced asthmatic attacks more frequently while cheerleading, which is an extracurricular activity. She received BT because she wanted to continue cheerleading. After the second BT session, she developed more sputum and cough. During the third session, white secretion and saccular bronchodilation appeared in the left lower bronchus. Aspergillus fumigatus was detected in the culture of the bronchial lavage sample, and saccular bronchodilation in the affected bronchus was observed on computed tomography (CT). Five months after the start of oral itraconazole, her subjective symptoms as well as her CT findings improved. Her asthma condition improved enough for the patient to continue cheerleading without exacerbation. Conclusions: It is necessary to consider the possibility of respiratory tract infections including fungal infections after BT. Detailed observations of the entire bronchus and sample collection for microbial culture are highly recommended. Keywords: Aspergillosis, Saccular bronchodilation, Bronchial thermoplasty, Severe asthma, Case report Background Bronchial thermoplasty (BT) is a medical procedure in which bronchoscopy is used and controlled thermal energy is applied to the bronchial wall to decrease the smooth muscles. This procedure is also effective for the treatment of severe asthma. Bronchial edema and radiological changes are commonly known major complications of BT, but infections are rarely reported. The AIR2 trial reported that only one patient with lower respiratory tract infection required hospitalization in the BT group *Correspondence: [email protected] 1 Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, 1‑4‑17 Mita, Minato‑ku, Tokyo 108‑0073, Japan Full list of author information is available at the end of the article
[1]. Here, we present a case of aspergillosis after BT in a young asthmatic patient.
Case presentation The patient was a 19-year-old woman with no comorbidities other than asthma. She was a non-smoker. She had been treated for severe asthma with high doses of inhaled corticosteroids plus long-acting β2-agonists, antileukotriene, theophylline, and antihistamine. The patient participated in cheerleading as an extracurricular activity at her college. During cheerleading, she experienced asthmatic attacks, which became increasingly frequent, and she therefore sought medical consultation. The patient
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