Long-Term Stability of Allergic Bronchopulmonary Mycosis After Bronchoscopic Removal of Mucus Plugs: A Six-Year Follow-Up Case Report

Sep 30, 2026

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A 37-year-old man with treated asthma developed fever and dyspnea with pronounced peripheral eosinophilia (10,400/µL) and markedly elevated total IgE (463.2 IU/mL). Imaging showed multiple mucus plugs with central bronchiectasis, and bronchoscopy identified plugs in the tracheal bifurcation and lower bronchi. Penicillium citrinum grew from removed material, and pathology demonstrated necrotic debris, exudates, mucus, and Charcot-Leyden crystals, fulfilling ABPM criteria. After bronchoscopic mucus plug removal, rapid improvement occurred without pharmacological therapy, with no recurrence for over six years.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

Introduction

Case Presentation

Review began 11/25/2025 Review ended 12/05/2025 Published 12/10/2025 © Copyright 2025 Araya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98885 Open Access Case Report Long-Term Stability of Allergic Bronchopulmonary Mycosis After Bronchoscopic Removal of Mucus Plugs: A Six-Year Follow-Up Case Report Tomoyuki Araya 1 , Toshiyuki Kita 1 , Takayuki Higashi 1, Ryo Hara 1, Hazuki Takato 1 1. Respiratory Medicine, National Hospital Organization (NHO) Kanazawa Medical Center, Kanazawa, JPN Corresponding author: Tomoyuki Araya, [komatsu_alone@yahoo.co.jp](komatsu_alone@yahoo.co.jp) Abstract A 37-year-old man with asthma under treatment presented with fever and dyspnea, accompanied by marked peripheral eosinophilia (10,400/µL) and elevated total immunoglobulin E (IgE) levels (463 .2 IU/mL) . Chest computed tomography demonstrated multiple mucus plugs in the right upper lobe and bilateral lower lobes, accompanied by central bronchiectasis. Bronchoscopy revealed mucus plugs in the tracheal bifurcation and lower bronchi. Cultures of the removed sputum and mucus plugs grew Penicillium citrinum. Pathology of the mucus plugs showed necrotic and degenerated cells, exudates, mucus, and Charcot-Leyden crystals. Based on these clinical, serological, and radiological findings, the diagnostic criteria for allergic bronchopulmonary mycosis (ABPM) were fulfilled. Following bronchoscopic removal of the mucus plugs led to rapid improvement without pharmacological therapy. No recurrence was observed for more than six years. This rare case suggests that bronchoscopic mucus plug removal may serve not only for diagnosis but also as an effective therapeutic option in selected patients with ABPM caused by Penicillium citrinum. Categories: Internal Medicine, Pulmonology, Allergy/Immunology Keywords: allergic asthma, allergic bronchopulmonary mycosis, flexible fiberoptic bronchoscopy (ffb), mucus plug, penicillium citrinum Introduction Allergic bronchopulmonary mycosis (ABPM) is a chronic inflammatory airway disorder in which saprophytic fungi colonizing the bronchi trigger type I and type III hypersensitivity reactions [1] . This immune response leads to mucus hypersecretion, airway obstruction, and, in some patients, progressive bronchiectasis. Diagnosis is typically based on the clinical criteria proposed by Asano et al. [2], incorporating asthma-like symptoms, peripheral eosinophilia, elevated serum immunoglobulin E (IgE), fungus-specific IgE/immunoglobulin G antibodies, characteristic radiologic findings, and identification of the causative organism. While Aspergillus species are most commonly implicated, biopsy-based analyses such as that by Ishiguro et al. have shown that other fungi, including Schizophyllum commune and Penicillium species, can also cause ABPM [3] . Environmental Penicillium species are known to be widespread and possess IgE-reactive allergens, indicating that non-Aspergillus fungi may contribute to allergic airway disease in susceptible individuals [4] . Standard therapy for ABPM consists of systemic corticosteroids and oral azole antifungals [5] . However, several reports describe patients who improved solely after bronchoscopic removal of mucus plugs [6-10], indicating that relieving airway obstruction can be therapeutic in select cases. Here, we describe a rare case of ABPM caused by Penicillium citrinum in which clinical improvement was achieved after bronchoscopic mucus plug removal alone. Case Presentation A 37-year-old man presented with a one-month history of recurrent fever and worsening dyspnea. His past medical history was notable only for trigeminal neuralgia. He had no known allergies and no relevant family history. His smoking history amounted

FAQs

What symptoms and laboratory findings supported the ABPM diagnosis in this case?

The patient had recurrent fever and worsening dyspnea, marked peripheral eosinophilia (10,400/µL), and elevated total IgE (463.2 IU/mL). Imaging and serologic findings, along with organism identification, supported ABPM diagnostic criteria.

How was the causative organism identified?

Cultures from the removed sputum and mucus plugs grew Penicillium citrinum, and pathology of the mucus plugs showed necrotic and degenerated cells, exudates, mucus, and Charcot-Leyden crystals.

What was the long-term outcome after bronchoscopic removal?

Bronchoscopic mucus plug removal led to rapid improvement without pharmacological therapy, and no recurrence was observed for more than six years.

Sep 30, 2026

Uploaded by Angel