{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:23:13Z","timestamp":1782476593694,"version":"3.54.5"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005088","name":"Beijing Municipal Health Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005088","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    Chronic pulmonary aspergillosis (CPA) is an increasingly recognized complication of both active and treated pulmonary tuberculosis (PTB). Optimal treatment for CPA in PTB patients has not been established. Here, we report a 36-years-old female with a history of childhood pulmonary tuberculosis presenting with persistent low-grade fever after COVID-19 infection. Imaging showed right upper lobe consolidation and bronchial occlusion. Laboratory investigations revealed positive bronchoalveolar lavage fluid (BALF) and serum galactomannan, and microbiological analyses including targeted Next-Generation Sequencing (tNGS) identified\n                    <jats:italic>Aspergillus terreus<\/jats:italic>\n                    , consistent with a diagnosis of CPA. Systemic voriconazole was ineffective due to subtherapeutic drug levels and was complicated by visual adverse effects. Multimodal interventional bronchoscopy was performed, including Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA), electrosurgical incision, balloon dilation, cryotherapy, and local antifungal perfusion. Clinical and radiological improvement was achieved, with resolution of fever, lesion absorption on CT, and negative microbiological and GM results. This case indicates that customized multimodal interventional bronchoscopy is a feasible and effective strategy for post-tubercular chronic pulmonary aspergillosis with bronchial occlusion when systemic antifungals are not optimal.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1797581","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:41:29Z","timestamp":1778823689000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Multimodal interventional bronchoscopy for chronic pulmonary Aspergillus infection with post-tubercular bronchial occlusion: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenjie","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaxu","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxia","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"100019","DOI":"10.1016\/j.clinme.2024.100019","article-title":"Chronic pulmonary aspergillosis - a guide for the general physician.","volume":"24","author":"Carter","year":"2026","journal-title":"Clin Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e0259766","DOI":"10.1371\/journal.pone.0259766","article-title":"Clinical manifestations, associated risk factors and treatment outcomes of Chronic pulmonary aspergillosis (CPA): experiences from a tertiary care hospital in Lahore, Pakistan.","volume":"16","author":"Akram","year":"2021","journal-title":"PLoS One."},{"key":"B3","doi-asserted-by":"publisher","first-page":"727","DOI":"10.2169\/internalmedicine.52.9142","article-title":"Prognostic factors in 194 patients with chronic necrotizing pulmonary aspergillosis.","volume":"52","author":"Nakamoto","year":"2013","journal-title":"Intern Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1080\/14787210.2026.2631525","article-title":"Post-tuberculosis lung disease and pulmonary aspergillosis management: challenges and considerations.","volume":"24","author":"Sehgal","year":"2026","journal-title":"Expert Rev Anti Infect Ther."},{"key":"B5","doi-asserted-by":"publisher","first-page":"864","DOI":"10.2471\/BLT.11.089441","article-title":"Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis.","volume":"89","author":"Denning","year":"2011","journal-title":"Bull World Health Organ."},{"key":"B6","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1007\/s11046-022-00676-z","article-title":"Challenges, characteristics, and outcomes of chronic pulmonary aspergillosis: a 11-year experience in a middle-income country.","volume":"188","author":"de Oliveira","year":"2023","journal-title":"Mycopathologia."},{"key":"B7","doi-asserted-by":"publisher","first-page":"673","DOI":"10.17863\/CAM.80907","article-title":"Chronic pulmonary aspergillosis: a brief review.","volume":"94","author":"Zarif","year":"2021","journal-title":"Yale J Biol Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e70060","DOI":"10.1111\/myc.70060","article-title":"Prevalence of chronic pulmonary aspergillosis in patients with mycobacterial and non-mycobacterial tuberculosis infection of the lung: a systematic review and meta-analysis.","volume":"68","author":"Sehgal","year":"2025","journal-title":"Mycoses."},{"key":"B9","doi-asserted-by":"publisher","first-page":"547","DOI":"10.3892\/etm.2017.4540","article-title":"Endobronchial aspergilloma: a case report and literature review.","volume":"14","author":"Huang","year":"2017","journal-title":"Exp Ther Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"787","DOI":"10.3349\/ymj.2011.52.5.787","article-title":"Endobronchial aspergilloma: report of 10 cases and literature review.","volume":"52","author":"Ma","year":"2011","journal-title":"Yonsei Med J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1183\/13993003.00583-2015","article-title":"Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management.","volume":"47","author":"Denning","year":"2016","journal-title":"Eur Respir J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"20499361241253751","DOI":"10.1177\/20499361241253751","article-title":"Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges.","volume":"11","author":"Tashiro","year":"2024","journal-title":"Ther Adv Infect Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1007\/s12281-017-0304-7","article-title":"The management of Chronic pulmonary aspergillosis: the UK national aspergillosis centre approach.","volume":"11","author":"Maghrabi","year":"2017","journal-title":"Curr Fungal Infect Rep."},{"key":"B14","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.simyco.2020.05.002","article-title":"Classification of Aspergillus, Penicillium, Talaromyces and related genera (Eurotiales): an overview of families, genera, subgenera, sections, series and species.","volume":"95","author":"Houbraken","year":"2020","journal-title":"Stud Mycol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"776.e1","DOI":"10.1016\/j.cmi.2017.04.012","article-title":"A prospective international Aspergillus terreus survey: an EFISG, ISHAM and ECMM joint study.","volume":"23","author":"Risslegger","year":"2017","journal-title":"Clin Microbiol Infect."},{"key":"B16","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1093\/cid\/ciz287","article-title":"Selection of oral antifungals for initial maintenance therapy in Chronic pulmonary Aspergillosis: a longitudinal analysis.","volume":"70","author":"Tashiro","year":"2020","journal-title":"Clin Infect Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"75","DOI":"10.3390\/jof6020075","article-title":"Chronic pulmonary aspergillosis: notes for a clinician in a resource-limited setting where there is no mycologist.","volume":"6","author":"Bongomin","year":"2020","journal-title":"J Fungi."},{"key":"B18","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1055\/s-0043-1776913","article-title":"Chronic pulmonary aspergillosis as a considerable complication in post-tuberculosis lung disease.","volume":"45","author":"Neub\u00f6ck","year":"2024","journal-title":"Semin Respir Crit Care Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1016\/j.jtcvs.2009.01.019","article-title":"Pulmonary aspergilloma: analysis of prognosis in relation to symptoms and treatment.","volume":"138","author":"Lee","year":"2009","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1603","DOI":"10.1016\/j.athoracsur.2010.02.037","article-title":"Surgery for pulmonary aspergilloma in immunocompetent patients: no benefit from adjuvant antifungal pharmacotherapy.","volume":"89","author":"Sagan","year":"2010","journal-title":"Ann Thorac Surg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2643","DOI":"10.2169\/internalmedicine.8202-21","article-title":"Obstructive pneumonia associated with endobronchial aspergilloma: successful treatment with interventional bronchoscopy and antifungals.","volume":"61","author":"Komatsu","year":"2022","journal-title":"Intern Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1167475","DOI":"10.3389\/fphar.2023.1167475","article-title":"Bronchoscopic instillation of amphotericin B is a safe and effective measure to treat pulmonary mycosis.","volume":"14","author":"Yang","year":"2023","journal-title":"Front Pharmacol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"101385","DOI":"10.1016\/j.mycmed.2023.101385","article-title":"Instillation of Amphotericin B by bronchoscopy combined with systemic voriconazole in advanced non-small cell lung cancer patients with chronic cavitary pulmonary aspergillosis: a case series and literature review.","volume":"33","author":"Wu","year":"2023","journal-title":"J Mycol Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e70192","DOI":"10.1002\/rcr2.70192","article-title":"Intracavitary instillation of antifungal medication.","volume":"13","author":"Zhang","year":"2025","journal-title":"Respirol Case Rep."},{"key":"B25","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1159\/000525376","article-title":"Efficacy of intrabronchial voriconazole instillation for inoperable pulmonary Aspergilloma: a pilot randomized controlled trial.","volume":"101","author":"Hadda","year":"2022","journal-title":"Respiration."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1797581\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:41:30Z","timestamp":1778823690000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1797581\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":25,"alternative-id":["10.3389\/fmed.2026.1797581"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1797581","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]},"article-number":"1797581"}}