WITHDRAWN: Bronchopulmonary aspergillosis coexisting with bronchopulmonary tuberculosis in a middle-aged patient: case report

We report the case of a 36-year-old male with a six-day history of intermittent fever, chills, headache, sore throat, cough, and black phlegm with blood streaks. The patient was diagnosed with tuberculosis based on TB DNA testing using GeneXpert MTB/RIF and TB-LAMP assays from the morning sputum sample. Simultaneously, sputum fungal test under microscope with moderate spores and hyphae, a positive 1,3-beta-D glucan test (G test), a positive galactomannan test (GM+) in broncholavage fluid, and a bronchoscopy biopsy confirmed pulmonary aspergillosis. Therefore, the patient was initiated on dual therapy, including voriconazole intravenous infusion, local infusion, and nebulization of amphotericin B and antitubercular drugs). However, continuous adjustment of quadruple antituberculosis treatment (isoniazid, ethambutol, levofloxacin, and aminoglycosides) was difficult due to drug interactions (rifampicin and voriconazole) and the side effects of the medication. Fungal treatment with voriconazole has not been discontinued; the patient underwent six bronchoscopy examinations and treatments in three months. After comprehensive treatment, the patient’s condition improved significantly, with a substantial resolution.