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

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.