Pulmonary Aspergillus overlap syndrome in a patient with bronchial asthma

Allergic bronchopulmonary aspergillosis (ABPA) is a disease of immunocompetent patients, and invasive pulmonary aspergillosis is seen in immunocompromised patients. Hence, pulmonary Aspergillus overlap syndrome presenting with ABPA and invasive aspergillosis is extremely rare. We report a case of well-controlled bronchial asthma who presented with acute exacerbation and hypoxaemic respiratory failure. The chest imaging showed bilateral patchy consolidation. Sputum culture revealed Pseudomonas aeruginosa Video bronchoscopy showed dense greyish-white membranes studded all over the tracheobronchial tree. On further evaluation and bronchoscopic biopsy, she was diagnosed with an overlap of ABPA and invasive pseudomembranous Aspergillus tracheobronchitis with a secondary P. aeruginosa infection. She responded well to antifungal therapy, resulting in good clinico-radiological resolution, but developed some residual lung damage. Ours is the first report on pseudomembranous Aspergillus tracheobronchitis (a form of invasive pulmonary aspergillosis) with ABPA overlap, although ABPA has been reported with other forms of invasive aspergillosis.