Abstract
Background: Bronchiectasis remains incompletely understood regarding its causes, progression, and treatment strategies. It frequently arises as a secondary condition, underscoring the need to include it as a differential diagnosis during clinical evaluation. Case Presentation: A 35-year-old woman with type 2 severe bronchial asthma presented with persistent symptoms two weeks after bronchial thermoplasty (BT). Chest computed tomography revealed bronchial wall thickening and bronchiectasis in the left B8 bronchus. Bronchoscopy showed cultures positive for Aspergillus fumigatus from bronchial lavage fluid, and transbronchial biopsy revealed hyphae. The patient was diagnosed with bronchial aspergillosis localized to the left B8 bronchus as a postoperative complication of BT. Treatment with voriconazole for six months led to gradual improvement in bronchial aspergillosis, with imaging showing resolution of bronchial wall thickening and a trend toward improvement in bronchiectasis. Persistent yellow sputum prompted repeat bronchoscopy, revealing negative Aspergillus fumigatus cultures but positive Staphylococcus aureus, indicating localized bronchiectasis with chronic airway infection. Symptoms partially improved with low-dose erythromycin after limited response to repeated amoxicillin/clavulanic acid. Asthma control also improved post-BT. Conclusions: Bronchial aspergillosis is a rare complication of BT that can progress to localized bronchiectasis and chronic airway infections, necessitating careful long-term follow-up. The disease course appears similar to other types of bronchiectasis, even when it develops as a complication of BT.
Published Version
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