Chronic Pulmonary Aspergillosis Secondary Infection: A Case Report of <i>Achromobacter</i> spp. Lung Infection

Both pulmonary tuberculosis (PTB) and coronavirus disease-2019 (COVID-19) are risk factors for chronic pulmonary aspergillosis (CPA) and other pulmonary infectious diseases because of residual lung damage. We report a case of Achromobacter spp. infection following CPA in an immunocompetent woman with a history of PTB and COVID-19. A 63-year-old Cameroonian woman presented in November 2021 with a history of cough with productive muco-purulent sputum, asthenia, headaches, and chest pain for 8 weeks. There was no history of hemoptysis or difficulty in breathing. She was treated for PTB in 2002 and COVID-19 in 2020 and had no other underlying co-morbidities. Chest X-ray showed bronchiectasis in the right lung and features of healed PTB. SARS-CoV-2 antigen, antibody, and real-time polymerase chain reaction tests were negative. Microscopy and GeneXpert MTB/RIF on the sputum sample were both negative. Sputum samples grew Aspergillus flavus complex and Aspergillus niger complex, and serum Aspergillus -specific IgG-IgM antibody was positive, suggestive of CPA. She showed significant clinical improvement on itraconazole tablets 200 mg (every 12 h) after 4 months of therapy. She presented 1 month later with severe symptomatic relapse and elevated white blood cells (27,000 cells/μL). Antibiotic therapy with amoxicillin + clavulanic acid and subsequently with ceftriaxone was unsuccessful. Chest CT scan showed a middle right mediastinal tissue mass with crenulated edges. Bronchoalveolar lavage (BAL) and lung biopsy testing yielded a negative result for PTB, invasive aspergillosis, and lung cancer. However, the BAL sample grew Achromobacter spp. She was initiated on imipenem 1 g (3 g/day × 10 days) with resolution of symptoms. This case suggests that because of the high burden of TB and COVID-19 in Cameroon, pulmonary bacterial and fungal superinfections are underreported. CPA is presently undiagnosed and underreported in Cameroon. Further investigations should be performed in patients not responding to usual antibiotics.