Bronchoscopic lesion resection combined with endobronchial instillation as a salvage therapy for a patient with complex aspergilloma complicated by non-tuberculous mycobacterial infection: case report

Background The infection rate of Aspergillus after non-tuberculous mycobacterial lung disease shows a persistent upward trend. While current treatment options for patients with complex pulmonary aspergillosis remains under investigation, the optimal treatment strategy remains under investigation. Case presentation A 66-years-old female was diagnosed with non-tuberculous mycobacterial lung disease complicated by a complex pulmonary aspergilloma involving the posterior segment of the right upper lobe and the dorsal segment of the right lower lobe. Due to scattered lesions and multiple underlying diseases, surgical resection could not be performed. Instead, based on oral low-dose voriconazole systemic antifungal therapy of 100 mg twice daily, four sessions of bronchoscopic lesion resection with biopsy forceps, and endobronchial instillation of liposomal amphotericin B 10 mg were selected. Finally, the aspergilloma disappeared, and the patient’s symptoms were relieved. Conclusion This case report suggests that for patients with complex pulmonary aspergilloma and non-tuberculous mycobacterial lung infection who are ineligible for surgery and cannot tolerate high-dose systemic antifungal therapy, bronchoscopic lesion resection combined with endobronchial instillation therapy may represent a feasible treatment option with potential clinical benefits. It also serves as a reminder to remain vigilant for the occurrence of aspergillosis following non-tuberculous mycobacterial lung disease.