Introduction: Bronchial thermoplasty (BT) is a novel brochoscopic intervention for severe bronchial asthma. Previous reports demonstrated that BT decreased frequency of asthma exacerbation and improved asthma related quality of life. Adverse effects included not only minor transient pulmonary complications but also severe complications like atelectasis and hemoptysis due to pseudoaneurysms. We report a first case of bronchial aspergillosis developed after bronchial thermoplasty. Case Description: A 28-year-old woman with severe bronchial asthma had been treated with high-dose inhaled corticosteroids, long-acting beta-agonist, long-acting muscarinic antagonist, Leukotriene receptor antagonist, omalizumab, and oral corticosteroids and was yet under poor control of asthma. Specific IgE antibody was positive for mite, Japanese cedar pollen, and Aspergillus. We performed bronchial thermoplasty to improve her asthma management. Exacerbation of asthma and hemosputum transiently emerged after the initiation of BT. After the final procedure she produced hemosputum intermittently. Three months after, CT revealed ectasis, thickening, and deformity of the bronchial wall in the left lower lobe where bronchial thermoplasty was applied. Bronchoscopy revealed ulcer and mucus plugs in the left lower lobe bronchi (figure 1). The biopsy specimens demonstrated invasion of neutrophils and branched filamentous fungal hyphae in the bronchial walls. Based on the detection of Aspergillus fumigatus from the sputum culture, we diagnosed her with bronchial aspergillosis. Discussion: Although we could not find any previous reports indicating destruction of airway structure by BT, bronchiectasis was demonstrated in this case. The patient revealed positive for Aspergillus specific IgE as some asthma patients sensitized to fungi and was suspected of allergic bronchopulmonary aspergillosis(ABPA). However, the inflammation of bronchial walls in this patient was primarily neutrophilic and the final diagnosis of bronchial aspergillosis was made. We suspected that BT caused mucosal damage which lead to infection of the fungi. In addition, high dose oral steroids administered before the procedure of BT might have caused immunosuppression, resulting in fungal infection. We must consider the risk of fungal infection after BT for patients with bronchial asthma sensitized to fungi including ABPA.
Full conference title:
- ATS 2018