A clinical analysis of 7 cases of allergic bronchopulmonary aspergillosis

Abstract

To study the clinical features, diagnosis and treatment of allergic bronchopulmonary aspergillosis (ABPA). The clinical presentations, serologic results, chest radiology, pathological results and treatment of 7 patients with ABPA in Chinese PLA General Hospital were retrospectively analyzed. There were 4 males and 3 females, with a mean age of (33 ± 16) years. Before the diagnosis of ABPA, 6 cases had been misdiagnosed as bronchial asthma, 3 as pulmonary infection, 2 as tuberculosis and 1 as bronchiectasis. The main clinical manifestations included cough (n = 6), sputum production (n = 5), hemoptysis (n = 4), wheeze (n = 3), dyspnea(n = 3) and fever(n = 2). All cases had increased total serum IgE levels (median 3040 U/ml) and peripheral blood eosinophil count (median 0.19). Six of them showed increased peripheral eosinophil count median 1.84 × 10(9)/L, and skin test positive for Aspergillus antigen. Five of them had increased serum IgE antibodies specific to A. fumigatus (22 ± 15) kU/L, and 4 had increased serum IgG antibodies specific to A. fumigatus (108 ± 96) mg/L. The chest CT scan findings included transient or fixed pulmonary opacities, central bronchiectasis and finger-in-glove opacities. Five patients were treated with corticosteroids combined with antifungal therapy. Clinical features of ABPA include a history of asthma, elevation of the total serum IgE levels, presence of aspergillus IgE antibodies, peripheral eosinophilia, and transient or fixed pulmonary opacities and central bronchiectasis. Patients with asthma complicated with bronchiectasis should be routinely screened for Aspergillus skin test, and measurement of total serum IgE levels and chest CT scan are useful for confirmation of the diagnosis of ABPA. Oral glucocorticoids and anti-fungal drugs are effective in treatment of ABPA. Regular follow-up is needed for prevention of recurrence.