To improve the understanding, diagnosis, and treatment of mixed types of pulmonary aspergillosis (MTPA).

The clinical data of 21 patients with MTPA treated at Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University from January 2013 to July 2021 were analyzed retrospectively.

Of the 21 MTPA patients included in this study, 3 had allergic bronchopulmonary aspergillosis (ABPA) + invasive pulmonary aspergillosis (IPA) and 18 had aspergilloma + IPA; 95.2% had intrapulmonary structural lesions. For patients with ABPA+IPA, they had an average age of (38.0±14.4) years and 66.7% had a history of asthma. For patients with aspergilloma +IPA, they had an average age of (54.8±11.5) years and none had a history of asthma. There were significant differences in age and asthma history between the two groups (P＜0.05). In the ABPA+IPA group, the main symptoms were cough and sputum (100%) and dyspnea (66.7%); in the Aspergilloma+IPA group, cough and sputum (100%) and hemoptysis (61.1%) were common. Eleven (11/19) cases were positive for blood galactomannan (GM) detection and ten (10/12) were positive for bronchoalveolar lavage fluid GM detection. Regarding imaging manifestations the ABPA+IPA group mainly showed pulmonary nodules, masses, or high-density shadows (100%), toothpaste sign, finger sleeve sign (66.7%), bronchiectasis (100%), and halo sign (33.3%), while the aspergilloma+IPA group often had pulmonary nodules, masses, or high-density shadows (94.4%), air crescent sign (44.4%), bronchiectasis (50.0%), cavity (88.9%), and halo sign (22.2%); only the toothpaste sign and finger sleeve sign were statistically different between the two groups (P＜0.05). With regard to treatment and outcome: the 3 cases (100%) in the ABPA+IPA group were improved after antifungal therapy combined with systemic hormone therapy. In the aspergilloma+IPA group, 9 cases (50.0%) were treated with antifungal drugs, 2 (11.1%) were treated by lobectomy, and 7 (38.9%) were treated by lobectomy and antifungal therapy; 16 cases (88.9%) were improved, and 2 (11.8%) were worsened.

MTPA is rare, and underlying pulmonary structural diseases are one of the main host factors. The main symptoms of ABPA+IPA are cough, sputum, and dyspnea, while those for ABPA+IPA are cough, sputum, and hemoptysis. GM detection is helpful in the diagnosis of overlapping IPA type MTPA. Chest imaging plays an important role in the diagnosis of MTPA. Antifungal therapy combined with systemic hormone therapy is an effective method to treat ABPA+IPA. The treatment of patients with aspergilloma+IPA needs to be individualized. Simple antifungal therapy or operation combined with antifungal therapy is effective.