# Diagnostic and Therapeutic Challenges in Bronchiectasis With Concurrent Allergic Bronchopulmonary Aspergillosis and Non-tuberculous Mycobacterial Infection: A Case Report

## TL;DR

This case report discusses the challenges of managing a patient with bronchiectasis, ABPA, and NTM infection, emphasizing the need for personalized treatment and multidisciplinary care.

## Contribution

The paper presents a unique case highlighting the complexities of treating overlapping pulmonary conditions and the importance of tailored therapeutic approaches.

## Key findings

- The patient's treatment was complicated by immunosuppressive requirements for ABPA and the risk of worsening NTM infection.
- Itraconazole monotherapy was ineffective due to subtherapeutic drug levels and logistical barriers.
- The case emphasizes the need for close multidisciplinary collaboration and consistent follow-up in complex bronchiectasis cases.

## Abstract

Bronchiectasis is a chronic respiratory disorder that predisposes patients to recurrent infections and airway inflammation. The coexistence of allergic bronchopulmonary aspergillosis (ABPA) and non-tuberculous mycobacterial (NTM) infection in the setting of bronchiectasis presents a significant diagnostic and therapeutic challenge.

This case report describes a 57-year-old male with a history of asthma and bronchiectasis who developed concurrent ABPA and Mycobacterium chimaera-intracellulare infection. Management was complicated by the immunosuppressive requirements of ABPA treatment, which posed a risk for exacerbating the NTM infection. The patient was initiated on itraconazole monotherapy with therapeutic monitoring, but subtherapeutic drug levels and treatment discontinuation due to logistical barriers limited its effectiveness. This case underscores the importance of individualized treatment strategies, close multidisciplinary collaboration, and the need for consistent follow-up in patients with overlapping pulmonary conditions. It highlights the critical balance between immunosuppression and infection control in complex bronchiectasis cases, as well as the systemic challenges that can disrupt optimal care delivery.