Korean J Pediatr.  2015 May;58(5):190-193. 10.3345/kjp.2015.58.5.190.

Case of seropositive allergic bronchopulmonary aspergillosis in a 10-year-old girl without previously documented asthma

• Shin JE
• Shim JW
• Kim DS
• Jung HL
• Park MS
• Shim JY

• KMID: 1795128
• DOI: http://doi.org/10.3345/kjp.2015.58.5.190

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity lung disease due to bronchial colonization of Aspergillus fumigatus that occurs in susceptible patients with asthma or cystic fibrosis. A 10-year-old girl was referred to the Department of Pediatric Pulmonology for persistent consolidations on chest radiography. Pulmonary consolidations were observed in the right upper and left lower lobes and were not resolved with a 4-week prescription of broad-spectrum antibiotics. The patient had a history of atopic dermatitis and allergic rhinitis but no history of asthma. She had no fever but produced thick and greenish sputum. Her breathing sounds were clear. On laboratory testing, her total blood eosinophil count was 1,412/mm3 and total serum IgE level was 2,200 kU/L. Aspergillus was isolated in the sputum culture. The A. fumigatus-specific IgE level was 15.4 kU/L, and the Aspergillus antibody test was also positive. A chest computed tomography scan demonstrated bronchial wall thickening and consolidation without bronchiectasis. An antifungal agent was added but resulted in no improvement of pulmonary consolidations after 3 weeks. Pulmonary function test was normal. Methacholine provocation test was performed, revealing bronchial hyperreactivity (PC20=5.31 mg/mL). Although the patient had no history of asthma or bronchiectasis, ABPA-seropositivity was suspected. Oral prednisolone (1 mg/kg/day) combined with antifungal therapy was started. Pulmonary consolidations began decreasing after 1 week of treatment and completely resolved after 1 month. This is the first observed and treated case of seropositive ABPA in Korean children without previously documented asthma.

Keyword

Allergic bronchopulmonary aspergillosis; Aspergillus fumigatus; Asthma

MeSH Terms

Anti-Bacterial Agents
Aspergillosis, Allergic Bronchopulmonary*
Aspergillus
Aspergillus fumigatus
Asthma*
Bronchial Hyperreactivity
Bronchiectasis
Child*
Colon
Cystic Fibrosis
Dermatitis, Atopic
Eosinophils
Female
Fever
Humans
Hypersensitivity
Immunoglobulin E
Lung Diseases
Methacholine Chloride
Prednisolone
Prescriptions
Pulmonary Medicine
Radiography
Respiratory Function Tests
Respiratory Sounds
Rhinitis
Sputum
Thorax
Anti-Bacterial Agents
Immunoglobulin E
Methacholine Chloride
Prednisolone