Tuberc Respir Dis.  2015 Apr;78(2):133-136. 10.4046/trd.2015.78.2.133.

Allergic Bronchopulmonary Aspergillosis Presenting as Recurrent Mass-like Consolidation

• Choe YH

• KMID: 2320607
• DOI: http://doi.org/10.4046/trd.2015.78.2.133

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitive disease showing various radiographic and clinical manifestations. Its clinical course has not been fully understood. Here I describe a case of a 23-year-old immunocompetent man with frequently relapsing ABPA. He was asthmatic. He visited our hospital because of a chronic cough. Laboratory examination showed eosinophilia with increased total and Aspergillus-specific IgE as well as positive skin reaction to Aspergillus fumigatus. Radiologic feature was a dense consolidation. Histology showed organizing pneumonia with eosinophilic infiltration. On the diagnosis of ABPA, he was treated with systemic steroid and itraconazole. Although treatment response was excellent, he suffered from recurrent ABPA three times thereafter in the form of fleeting mass-like consolidation.

Keyword

Aspergillosis, Allergic Bronchopulmonary; Recurrence; Lung

MeSH Terms

Aspergillosis, Allergic Bronchopulmonary*
Aspergillus fumigatus
Cough
Diagnosis
Eosinophilia
Eosinophils
Humans
Immunoglobulin E
Itraconazole
Lung
Pneumonia
Recurrence
Skin
Young Adult
Immunoglobulin E
Itraconazole

Figure

• 

  Figure 1 Chest computed tomography showing radiologic feature of ABPA in a 23-year-old man. (A) On first visit; (B) At first relapse; (C) At second relapse; (D, E) At third relapse; (F) At 3 months after treatment of third relapse.

Reference

1. Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 2002; 110:685–692.

2. Bains SN, Judson MA. Allergic bronchopulmonary aspergillosis. Clin Chest Med. 2012; 33:265–281.

3. Agarwal R, Gupta D, Aggarwal AN, Behera D, Jindal SK. Allergic bronchopulmonary aspergillosis: lessons from 126 patients attending a chest clinic in north India. Chest. 2006; 130:442–448.

4. Agarwal R, Garg M, Aggarwal AN, Saikia B, Gupta D, Chakrabarti A. Serologic allergic bronchopulmonary aspergillosis (ABPA-S): long-term outcomes. Respir Med. 2012; 106:942–947.

5. Agarwal R. Allergic bronchopulmonary aspergillosis. Chest. 2009; 135:805–826.

6. Agarwal R, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A, Jindal SK. Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis: an analysis of 155 patients. Chest. 2007; 132:1183–1190.

7. Kiely JL, Spense L, Henry M, Hurley MF, Kelleher N, Bredin CP. Chest radiographic staging in allergic bronchopulmonary aspergillosis: relationship with immunological findings. Eur Respir J. 1998; 12:453–456.

8. Patterson R, Greenberger PA, Lee TM, Liotta JL, O’Neill EA, Roberts M, et al. Prolonged evaluation of patients with corticosteroid-dependent asthma stage of allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 1987; 80:663–668.

9. Miller PW, Hamosh A, Macek M Jr, Greenberger PA, MacLean J, Walden SM, et al. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in allergic bronchopulmonary aspergillosis. Am J Hum Genet. 1996; 59:45–51.

10. Rosa-Rosa L, Zimmermann N, Bernstein JA, Rothenberg ME, Khurana Hershey GK. The R576 IL-4 receptor alpha allele correlates with asthma severity. J Allergy Clin Immunol. 1999; 104:1008–1014.

11. Saxena S, Madan T, Shah A, Muralidhar K, Sarma PU. Association of polymorphisms in the collagen region of SP-A2 with increased levels of total IgE antibodies and eosinophilia in patients with allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 2003; 111:1001–1007.

12. Carvalho A, Pasqualotto AC, Pitzurra L, Romani L, Denning DW, Rodrigues F. Polymorphisms in toll-like receptor genes and susceptibility to pulmonary aspergillosis. J Infect Dis. 2008; 197:618–621.

13. Kauffman HF, Beaumont F, de Monchy JG, Sluiter HJ, de Vries K. Immunologic studies in bronchoalveolar fluid in a patient with allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 1984; 74:835–840.

14. Persson CG, Erjefalt JS, Erjefalt I, Korsgren MC, Nilsson MC, Sundler F. Epithelial shedding: restitution as a causative process in airway inflammation. Clin Exp Allergy. 1996; 26:746–755.