Abstract
BackgroundAllergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows.MethodsThis retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019, using criteria proposed by the International Society of Human and Animal Mycology (ISHAM), which focuses on positive specific IgE for Aspergillus fumigatus. Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed.ResultsBaseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP before diagnosis of ABPA (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7–18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2–9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse.ConclusionsThe ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.
Highlights
Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic
This pathology usually develops after the onset of bronchial asthma (BA) or cystic fibrosis [1] and prevalence rates of ABPA among adult asthmatic patients have been estimated as 2.5% in China and 7–22% in India [2]
Study patients Patients were included in the study if they fulfilled the diagnostic criteria for ABPA proposed by the International Society of Human and Animal Mycology (ISHAM) [2], which included a history of BA or cystic fibrosis and both of the following: (1) positive immediate cutaneous hypersensitivity to Aspergillus antigen or specific IgE to A. fumigatus, and (2) elevated total IgE level in serum > 1000 IU/ml
Summary
Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder caused by type 2 immune responses to Aspergillus. This pathology usually develops after the onset of bronchial asthma (BA) or cystic fibrosis [1] and prevalence rates of ABPA among adult asthmatic patients have been estimated as 2.5% in China and 7–22% in India [2]. Several diagnostic criteria for ABPA have been proposed, such as a history of BA or cystic fibrosis, characteristic radiographic pulmonary opacities including central dilatation of the bronchus, elevated immunoglobulin (Ig)E levels, and hypersensitivity reaction to Aspergillus including elevated IgE antibodies against Aspergillus fumigatus and/or IgG antibodies for Aspergillus [2, 4]. The detailed clinical and laboratory data characteristics of ABPA remain unclear even to pulmonologists, which might delay diagnosis and cause irreversible pulmonary damage [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
