Asia Pac Allergy.  2016 Jul;6(3):187-191. 10.5415/apallergy.2016.6.3.187.

Delayed diagnosis of allergic bronchopulmonary aspergillosis due to absence of asthmatic symptoms

• Kim Y
• Lee HY
• Gu KM
• Lee JY
• Yoon SW
• Park TY
• Choi JC
• Kim JY
• Park IW
• Shin JW
• Choi BW
• Jung JW

• KMID: 2400421
• DOI: http://doi.org/10.5415/apallergy.2016.6.3.187

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease with small prevalence. Exposure to aspergillus mold causes immunologic hypersensitivity and may cause ranges of symptoms from minimal to detrimental outcomes. Diagnosing and treating the disease before the development of bronchiectasis may save the patient from poor outcomes. This report presents a case of recurrent ABPA without any symptom of asthma, which impeded the correct diagnosis even after numerous hospitalizations.

Keyword

Aspergillosis, allergic bronchopulmonary; Aspergillus; Asthma; Bronchiectasis

MeSH Terms

Aspergillosis, Allergic Bronchopulmonary*
Aspergillus
Asthma
Bronchiectasis
Delayed Diagnosis*
Diagnosis
Fungi
Hospitalization
Humans
Hypersensitivity
Lung Diseases
Prevalence

Figure

• 

  Fig. 1 The radiographic findings during the current admission (August, 2015). The isolated, large consolidation (5.8 cm × 6.0 cm × 5.1 cm) with central bronchiectasis and mucoid bronchial impaction is found in the right upper lobe of lung parenchyme. (A) Chest simple radiograph, (B) cross section of the consolidation in high resolution chest computed tomography (CT), (C). cross section of the consolidation in enhanced chest CT (arrow: a reactive peribronchial lymph node enlargement, 1.2 cm), (D) sagittal section of the consolidation in enhanced chest CT.

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  Fig. 2 The radiologic findings during the past admissions. Past computed tomography (CT) findings reveal migrating consolidations all at different locations of lung. All CTs were taken during which the patient presented with respiratory symptoms. The patient presented with (A) consolidation in right lower lobe (November, 2011, event 1), (B) larger consolidation in left lower lobe (March, 2013, event 2), (C) consolidation in posterior part of right upper lobe (September, 2013. event 3), and (D) larger consolidation in posterior part of right upper lobe (November, 2013, event 4).

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  Fig. 3 (A) The bronchoscopic biopsy shows dense inflammatory infiltration in the bronchial wall (H&E, ×200). (B) The inflammatory cells are nonspecific, composed of lymphplasma cells, eosinophils, and histioid cells (H&E, ×400).

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  Fig. 4 (A) The follow-up chest radiographs show improvement of the lesion taken at day 7 of systemic corticosteroid and itraconazole, (B) 1 month later.

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