Bronchoscopic debridement and antifungal therapy as an effective non-surgical approach to concomitant aspergilloma and ABPA: A case report

Pulmonary aspergillosis refers to a spectrum of lung diseases caused by Aspergillus species, ranging from allergic manifestations such as allergic bronchopulmonary aspergillosis (ABPA) to chronic and invasive forms, including chronic cavitary pulmonary aspergillosis (CCPA) and aspergilloma. The coexistence of ABPA and aspergilloma is uncommon and poses unique therapeutic challenges, particularly in those unsuitable for surgical intervention. We present the case of a 26-year-old female with CCPA and concomitant ABPA. Despite prolonged antifungal therapy, imaging revealed a persistent left upper lobe aspergilloma accompanied by elevated total and Aspergillus -specific IgE levels. She subsequently underwent bronchoscopic debridement with peri-procedural itraconazole. Following the procedure, she demonstrated significant clinical and immunologic improvement, with more than a 20% reduction in IgE levels and normalization of pulmonary function, which had previously shown a restrictive pattern. This case highlights that a multimodal, minimally invasive approach integrating bronchoscopic debridement with peri-procedural antifungal therapy, offers a viable and effective alternative for non-surgical candidates, promoting both functional and immunologic recovery.