When COPD meets Aspergillus: A treatment Odyssey and critical insights from a 76-year-old female patient's journey: A case report.

RATIONALE: Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder characterized by persistent limitation of airflow. Fungal infections are not uncommon in patients with COPD. However, reports on the short-term improvement in lung function in COPD patients with IgE-negative Aspergillus tracheobronchitis (ATB) following antifungal treatment are currently rare. Here, we described a patient whose lung function significantly improved after antifungal treatment for COPD combined with ATB, along with the diagnostic process.

PATIENT CONCERNS: A 76-year-old female patient with COPD presented with worsening cough, expectoration, and wheezing. Despite some relief in respiratory symptoms after empirical antibiotic and anti-inflammatory treatment, her exercise tolerance did not return to pre-illness levels.

DIAGNOSES: Subsequently, a bronchoalveolar lavage fluid sample was sent for microbiological examination, which identified Aspergillus flavus (A flavus).

INTERVENTIONS: The patient was treated with voriconazole for one week as antifungal therapy.

OUTCOMES: The patient's subjective symptoms were further improved, and the modified British Medical Research Council dyspnea scale returned to the stable state before the exacerbation. A follow-up pulmonary function test showed an improvement of 880 mL in forced vital capacity and 620 mL in forced expiratory volume in one second.

LESSONS: Treatment of acute exacerbations of COPD must emphasize careful assessment of the patient's symptoms and remain vigilant for potential coexisting ATB.