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Allergic Bronchopulmonary Aspergillosis Presenting as Recurrent Mass-like Consolidation.

Choe YH - Tuberc Respir Dis (Seoul) (2015)

Bottom Line: He visited our hospital because of a chronic cough.Radiologic feature was a dense consolidation.Histology showed organizing pneumonia with eosinophilic infiltration.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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.
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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.

Mentions: On examination, the white blood-cell count was 7,610/µL with a 37.1% of eosinophil (2,410/µL). Screening test results for parasites were negative. Total IgE was 2,500 IU/mL and the serum level of Aspergillus-specific IgE was elevated (>50 kU/L). Aspergillus-specific IgG was also elevated (>200 mg/dL). Allergy skin prick test showed positive reactions to A. fumigatus. Pulmonary function test showed obstructive patterns with positive bronchodilator response, i.e., 410 mL (20%) increase from 2.00 L to 2.41 L of forced expiratory volume in 1 second (FEV1) of FEV1 after inhalation of beta2-agonist, 0.72 of FEV1/forced vital capacity ratio, decreased forced expiratory flow between 25% and 75% of functional vital capacity (FEF25-75%, 1.70 L; 36% of predictive value), and positive mannitol bronchial provocation test. High resolution computed tomography (HRCT) showed 3.3×2.0-cm-sized, ill-defined consolidation and peripheral ground glass opacity in the left lower lobe lateral basal segment (Figure 1A). Central or peripheral bronchiectasis was not demonstrated. The patient was referred for a video-assisted thoracoscopic biopsy of the consolidation in the left lower lobe. Histologic features were organizing pneumonia filled with eosinophil-dominant inflammatory exudates. His clinical and laboratory findings fulfilled the six major diagnostic criteria of ABPA proposed by Rosenberg-Patterson5 (i.e., asthma, pulmonary infiltration, immediate cutaneous hyperreactivity to Aspergillus, peripheral eosinophilia, elevated serum IgE over 1,000 IU/mL, serum A. fumigatus-specific IgG and IgE). On the diagnosis of ABPA, he began to be treated with 400 mg/day itraconazole and 1 mg/kg/day oral methylprednisolone. After 3 months later, consolidation in left lower lobe was completely disappeared. Blood eosinophil count became normalized (0.7%, 90/µL) and serum IgE level was decreased (1,632 IU/mL). So, steroid was slowly tapered and eventually wean. Regular radiologic and serologic work-up was performed thereafter.


Allergic Bronchopulmonary Aspergillosis Presenting as Recurrent Mass-like Consolidation.

Choe YH - Tuberc Respir Dis (Seoul) (2015)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388898&req=5

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.
Mentions: On examination, the white blood-cell count was 7,610/µL with a 37.1% of eosinophil (2,410/µL). Screening test results for parasites were negative. Total IgE was 2,500 IU/mL and the serum level of Aspergillus-specific IgE was elevated (>50 kU/L). Aspergillus-specific IgG was also elevated (>200 mg/dL). Allergy skin prick test showed positive reactions to A. fumigatus. Pulmonary function test showed obstructive patterns with positive bronchodilator response, i.e., 410 mL (20%) increase from 2.00 L to 2.41 L of forced expiratory volume in 1 second (FEV1) of FEV1 after inhalation of beta2-agonist, 0.72 of FEV1/forced vital capacity ratio, decreased forced expiratory flow between 25% and 75% of functional vital capacity (FEF25-75%, 1.70 L; 36% of predictive value), and positive mannitol bronchial provocation test. High resolution computed tomography (HRCT) showed 3.3×2.0-cm-sized, ill-defined consolidation and peripheral ground glass opacity in the left lower lobe lateral basal segment (Figure 1A). Central or peripheral bronchiectasis was not demonstrated. The patient was referred for a video-assisted thoracoscopic biopsy of the consolidation in the left lower lobe. Histologic features were organizing pneumonia filled with eosinophil-dominant inflammatory exudates. His clinical and laboratory findings fulfilled the six major diagnostic criteria of ABPA proposed by Rosenberg-Patterson5 (i.e., asthma, pulmonary infiltration, immediate cutaneous hyperreactivity to Aspergillus, peripheral eosinophilia, elevated serum IgE over 1,000 IU/mL, serum A. fumigatus-specific IgG and IgE). On the diagnosis of ABPA, he began to be treated with 400 mg/day itraconazole and 1 mg/kg/day oral methylprednisolone. After 3 months later, consolidation in left lower lobe was completely disappeared. Blood eosinophil count became normalized (0.7%, 90/µL) and serum IgE level was decreased (1,632 IU/mL). So, steroid was slowly tapered and eventually wean. Regular radiologic and serologic work-up was performed thereafter.

Bottom Line: He visited our hospital because of a chronic cough.Radiologic feature was a dense consolidation.Histology showed organizing pneumonia with eosinophilic infiltration.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

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.

No MeSH data available.


Related in: MedlinePlus