Diagnostic and Therapeutic Challenges in Bronchiectasis With Concurrent Allergic Bronchopulmonary Aspergillosis and Non-tuberculous Mycobacterial Infection: A Case Report

Bronchiectasis is a chronic respiratory disorder that predisposes patients to recurrent infections and airway inflammation. The coexistence of allergic bronchopulmonary aspergillosis (ABPA) and non-tuberculous mycobacterial (NTM) infection in the setting of bronchiectasis presents a significant diagnostic and therapeutic challenge. This case report describes a 57-year-old male with a history of asthma and bronchiectasis who developed concurrent ABPA and <i>Mycobacterium chimaera-intracellulare</i> infection. Management was complicated by the immunosuppressive requirements of ABPA treatment, which posed a risk for exacerbating the NTM infection. The patient was initiated on itraconazole monotherapy with therapeutic monitoring, but subtherapeutic drug levels and treatment discontinuation due to logistical barriers limited its effectiveness. This case underscores the importance of individualized treatment strategies, close multidisciplinary collaboration, and the need for consistent follow-up in patients with overlapping pulmonary conditions. It highlights the critical balance between immunosuppression and infection control in complex bronchiectasis cases, as well as the systemic challenges that can disrupt optimal care delivery.