Pulmonary <i>Aspergillus</i> overlap syndrome in a patient with bronchial asthma

Allergic bronchopulmonary aspergillosis (ABPA) is a disease of immunocompetent patients, and invasive pulmonary aspergillosis is seen in immunocompromised patients. Hence, pulmonary <i>Aspergillus</i> overlap syndrome presenting with ABPA and invasive aspergillosis is extremely rare. We report a case of well-controlled bronchial asthma who presented with acute exacerbation and hypoxaemic respiratory failure. The chest imaging showed bilateral patchy consolidation. Sputum culture revealed <i>Pseudomonas aeruginosa</i> Video bronchoscopy showed dense greyish-white membranes studded all over the tracheobronchial tree. On further evaluation and bronchoscopic biopsy, she was diagnosed with an overlap of ABPA and invasive pseudomembranous <i>Aspergillus</i> tracheobronchitis with a secondary <i>P. aeruginosa</i> infection. She responded well to antifungal therapy, resulting in good clinico-radiological resolution, but developed some residual lung damage. Ours is the first report on pseudomembranous <i>Aspergillus</i> tracheobronchitis (a form of invasive pulmonary aspergillosis) with ABPA overlap, although ABPA has been reported with other forms of invasive aspergillosis.