An unusual association between Mycobacterium tuberculosis and Aspergillus fumigatus

Allergic bronchopulmonary aspergillosis (ABPA) is rarely described outside the setting of asthma or cystic fibrosis. The occurrence of ABPA in other structural lung diseases included scars of old healed pulmonary tuberculosis (PTB) is also unknown. In this case, we report a 62- year old lady treated for PTB 40 years ago who presented with increasing dyspnea on exertion, cough with expectoration of blackish brown mucus plugs and wheezing. High-resolution computed tomographic scan of the thorax showed parenchymal fibrosis and volume loss in left upper lobe while central bronchiectasis, mosaic attenuation, centrilobular nodules with a tree-in-bud pattern were observed in the other lobes. Investigations revealed a diagnosis of ABPA. The patient was treated with prednisolone and showed a significant response. We review the current literature on this unusual association of previous and cured TB with ABPA, and also discuss the hypothesis of this possible relationship.