LUNG MASS AND HEMOPTYSIS IN AN ELDERLY MAN WITH CONTROLLED ASTHMA

Abstract

TYPE: Abstract Publication TOPIC: Allergy and Airway PURPOSE: To discuss a very unusual presentation/complication of longstanding asthma in an elderly non smoking male. METHODS: 88-year-old man with a past medical history of asthma previously well controlled and basal cell carcinoma presents to the emergency room with sub-massive hemoptysis. He had been having purulent phlegm and cough for 1 month. Computed tomography (CT) scan of the chest demonstrated large masslike area of consolidation in the right upper lobe measuring 7.5 cm. Bronchscoopy was performed demonstrating a fungating lesion at the entrance to the right upper lobe. Pathology of endobronchial biopsies consistent with respiratory mucosa with underlying thick smooth muscle bundles with myxoid changes and small lymphoid aggregates. Positron emission tomography (PET) CT suggested the mass was not FDG avid. Image: RESULTS: Wtihout a formal diagnosis the patient sought a second opinion. Subsequent work up revealed peripheral eosinophilia (9%), Positive IgE specific antibodies for Aspergillus Fumigatus, and total IgE elevated to >1900 IU/ml. Quantiferon TB was negative. A diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) was made. He was commenced on itraconazole 200mg twice daily and prednisone 20mg daily for 4months. Subsequent imaging demonstrated complete resolution of the mass with residual varicoid bronchiectasis. CONCLUSIONS: This case highlights an unsual presentation of ABPA. There are to our knowledge after literary review about 12 similar cases. Our case is particularly interesting because all prior descriptions occured in patients <65 years of age. CLINICAL IMPLICATIONS: ABPA should be considered in patients presenting with a lung mass and history of asthma when malignancy has been ruled out. DISCLOSURE: No significant relationships. KEYWORDS: allergic bronchopulmonary aspergillosis, LUNG MASS