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

ABSTRACT 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.