Suspected allergic bronchopulmonary candidiasis in a patient with concurrent multidrug-resistant bacterial pneumonia:...

Allergic bronchopulmonary candidiasis (ABPC) is a rare pulmonary hypersensitivity disorder; diagnosis is difficult because Candida albicans is usually a respiratory commensal.

A 70-year-old man with hypertension and prior cerebral infarction was admitted for sudden right limb weakness (6.5 hours) and diagnosed with hemorrhagic cerebral infarction in the intensive care unit.

Persistent fever and pulmonary infiltrates developed despite broad-spectrum antibiotics. Total immunoglobulin E (IgE) was 2181 IU/mL; sputum grew C albicans + carbapenem-resistant Pseudomonas aeruginosa; bronchoalveolar lavage fluid metagenomic next-generation sequencing detected C albicans, P aeruginosa, Klebsiella pneumoniae, EBV, and HSV-1. ABPC was suspected alongside multidrug-resistant bacterial pneumonia.

Ceftazidime-avibactam (2.5 g q8h) + nebulized polymyxin B (0.5 M IU q12h); oral voriconazole (400 mg q12h loading, then 200 mg q12h); IV methylprednisolone 40 mg/d.

Clinical improvement on combined therapy; respiratory stabilization within 2 weeks; intensive care unit transfer out. Follow-up chest computed tomography showed resolution of infiltrates; total IgE fell from 2181 to 995 IU/mL (-54%). Discharged with hemorrhagic cerebral infarction, hypertension, carbapenem-resistant Pseudomonas pneumonia, K pneumoniae co-infection, and ABPM.

Persistent infiltrates with high IgE and Candida isolation should suggest ABPM, not intensified antibiotics. ABPC can occur in older patients without asthma. Early corticosteroids plus antifungals yield rapid improvement. Metagenomic next-generation sequencing complements conventional testing but cannot confirm ABPC alone.