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Atypical Presentation of Allergic Bronchopulmonary Aspergillosis: An Unusual Cause of Difficult-to-Treat Asthma.
[allergic bronchopulmonary aspergillosis]
Allergic
Bronchopulmonary
aspergillosis
(
ABPA
)
commonly
presents
with
persistently
uncontrolled
asthma
,
despite
of
the
therapy
with
highest
possible
anti-
asthma
medications
.
Most
common
cause
of
ABPA
is
Aspergillus
fumigates
.
Hence
,
ABPA
is
one
of
the
important
differential
diagnoses
of
difficult-
to
-treat
asthma
.
Atypical
presentation
of
ABPA
misleads
the
diagnosis
and
asthma
remains
uncontrolled
.
Here
we
present
such
a
case
of
28
-
year
-old
non-smoker
,
normotensive
male
office
worker
who
presented
with
persistent
cough
with
scanty
white
,
mucoid
expectoration
and
gradually
progressive
breathlessness
with
bilateral
crackles
for
last
two
years
.
Diagnosis
of
asthma
was
made
based
on
clinical
evidences
and
spirometry
.
Anti-
asthma
treatment
was
started
and
gradually
stepped
up
.
Further
evaluation
was
done
due
to
lack
of
clinical
improvement
,
and
diagnosis
of
ABPA
was
made
from
bilateral
reticulonodular
lesions
on
HRCT
thorax
,
increased
levels
of
serum
IgE
and
Aspergillus
fumigates
specific
IgE
,
and
positive
aspergillin
skin
test
.
Oral
prednisolone
and
itraconazole
were
started
with
anti-
asthma
medications
.
