A case of Aspergillus and Nocardia infections after bronchial thermoplasty

Abstract

Bronchial thermoplasty (BT) is a bronchoscopic treatment for severe asthma. A 35-year-old woman with uncontrolled severe asthma despite maximal pharmacological treatment underwent BT and started coughing after the first procedure. One month later, during the second BT procedure, there were white ulcerous lesions on the right B9 bronchus. Culture of the bronchial brushing specimen showed Aspergillus fumigatus, for which voriconazole was started for treatment. On the third BT procedure, endobronchial mucus sampling demonstrated Nocardia spp., for which trimethoprim-sulfamethoxazole was given for three months. Seven months after the third BT procedure, no particular endobronchial lesions were found, and no abnormal pathogens were obtained by culture. The resulting bronchial infection in this case may be attributed to the use of systemic steroids, which rendered the patient immunocompromised, and to tissue fragility that was caused by the thermal energy from the BT procedure. Culture of endobronchial mucus should be considered during BT.

Keywords: Aspergillus; Nocardia; bronchial thermoplasty; severe asthma.

Figure 1

Findings during the bronchial thermoplasty (BT) procedures on the right B9 bronchus. Bronchoscopic images at (A) first BT, (B) second BT, and (C) third BT. (D) Photomicrograph of the bronchial brushing specimen during the second BT shows the presence of Y‐shaped hyphae (Papanicolaou stain, 40× magnification).

Figure 2

Chest computed tomography images before and after bronchial thermoplasty (BT). The images in the upper section are slices around the right segment B9, and the images in the lower section are slices around right lower lobe segments (A) before BT and after BT completion at (B) 1 month, (C) 7 months, and (D) 12 months.