Uncontrolled asthma and recurring pulmonary opacities: just asthma?

[allergic bronchopulmonary aspergillosis]

In asthma , when comorbidities and common causes of poor control have been considered and treated , the clinician may speculate , 'Is it all asthma ?'. In patients with uncontrolled atopic asthma with recurring episodes of symptoms mimicking pneumonia , the suspicion of allergic bronchopulmonary aspergillosis (ABPA ) should remain high . ABPA is caused by a complex immunological hypersensitivity reaction to colonisation with Aspergillus fumigatus in the bronchial tree , and is characterised by the presence of atopic asthma , blood eosinophilia , migrating pulmonary opacities and potential bronchiectasis . This case report describes a delay in diagnosing ABPA which was imitating pneumonia . The clinician should pay increased attention to ABPA and test for this in patients with uncontrolled asthma with an ongoing requirement for oral corticosteroids and /or antibiotics and with pulmonary opacities on chest imaging .