Allergic Bronchopulmonary Mycosis in Non-Atopic Patients: A Treatment Alternative

Abstract

RationaleAllergic bronchopulmonary mycosis (ABPM) is a chronic hypersensitivity reaction to molds that may present a diagnostic and treatment challenge because variants of this condition deviate from standard criteria. Our goal is to increase awareness about atypical permutations of this condition and offer a possible treatment option.MethodsTwo patients were evaluated with complete histories and physical examinations. Skin testing to 55 aeroallergens including 16 mold allergens was done by the prick method. Serum precipitins were done by the Ouchterlony technique. Computed tomography (CT) of the chest, pulmonary function testing (PFTs) including lung volumes and diffusion, bronchoscopy, and bronchial washing and cultures were done in both cases. Serology was drawn to measure total IgE and specific IgE. One case underwent a methacholine challenge and transbronchial biopsy. High-dose, mono-allergen subcutaneous immunotherapy was begun.ResultsNeither case had a history of allergic asthma. Both cases had histories, physical exams, CTs of the chest, and PFTs consistent with APBM. Both cases had a mono-positive skin test, Penicillium and Aspergillus respectively, with the former mold cultured from chest secretions. Both cases had a peripheral eosinophilia. One case had an elevated total serum IgE and positive precipitins. Both have remained in remission from APBM for more than 2 years while on high-dose immunotherapy.ConclusionsVariant presentations of APBM may be difficult to diagnose. High-dose immunotherapy may be an additional approach, particularly, to mono-sensitized patients. RationaleAllergic bronchopulmonary mycosis (ABPM) is a chronic hypersensitivity reaction to molds that may present a diagnostic and treatment challenge because variants of this condition deviate from standard criteria. Our goal is to increase awareness about atypical permutations of this condition and offer a possible treatment option. Allergic bronchopulmonary mycosis (ABPM) is a chronic hypersensitivity reaction to molds that may present a diagnostic and treatment challenge because variants of this condition deviate from standard criteria. Our goal is to increase awareness about atypical permutations of this condition and offer a possible treatment option. MethodsTwo patients were evaluated with complete histories and physical examinations. Skin testing to 55 aeroallergens including 16 mold allergens was done by the prick method. Serum precipitins were done by the Ouchterlony technique. Computed tomography (CT) of the chest, pulmonary function testing (PFTs) including lung volumes and diffusion, bronchoscopy, and bronchial washing and cultures were done in both cases. Serology was drawn to measure total IgE and specific IgE. One case underwent a methacholine challenge and transbronchial biopsy. High-dose, mono-allergen subcutaneous immunotherapy was begun. Two patients were evaluated with complete histories and physical examinations. Skin testing to 55 aeroallergens including 16 mold allergens was done by the prick method. Serum precipitins were done by the Ouchterlony technique. Computed tomography (CT) of the chest, pulmonary function testing (PFTs) including lung volumes and diffusion, bronchoscopy, and bronchial washing and cultures were done in both cases. Serology was drawn to measure total IgE and specific IgE. One case underwent a methacholine challenge and transbronchial biopsy. High-dose, mono-allergen subcutaneous immunotherapy was begun. ResultsNeither case had a history of allergic asthma. Both cases had histories, physical exams, CTs of the chest, and PFTs consistent with APBM. Both cases had a mono-positive skin test, Penicillium and Aspergillus respectively, with the former mold cultured from chest secretions. Both cases had a peripheral eosinophilia. One case had an elevated total serum IgE and positive precipitins. Both have remained in remission from APBM for more than 2 years while on high-dose immunotherapy. Neither case had a history of allergic asthma. Both cases had histories, physical exams, CTs of the chest, and PFTs consistent with APBM. Both cases had a mono-positive skin test, Penicillium and Aspergillus respectively, with the former mold cultured from chest secretions. Both cases had a peripheral eosinophilia. One case had an elevated total serum IgE and positive precipitins. Both have remained in remission from APBM for more than 2 years while on high-dose immunotherapy. ConclusionsVariant presentations of APBM may be difficult to diagnose. High-dose immunotherapy may be an additional approach, particularly, to mono-sensitized patients. Variant presentations of APBM may be difficult to diagnose. High-dose immunotherapy may be an additional approach, particularly, to mono-sensitized patients.