Diagnosis Of Allergic Bronchopulmonary Aspergillosis Research Articles

気管支肺胞洗浄液細胞診が有用であったアレルギー性気管支肺アスペルギルス症の 1 例

気管支肺胞洗浄液細胞診が有用であったアレルギー性気管支肺アスペルギルス症の 1 例

Childhood allergic bronchopulmonary aspergillosis presenting as a middle lobe syndrome

Allergic bronchopulmonary aspergillosis (ABPA) is infrequently documented in children with asthma. Although collapse is not uncommon, middle lobe syndrome (MLS) as a presentation of ABPA is rather a rarity. A 9-year-old female child with asthma presented with increase in intensity of symptoms along with a right midzone patchy consolidation on a chest radiograph. In addition, an ill-defined opacity abutting the right cardiac border with loss of cardiac silhouette was noted. A right lateral view confirmed a MLS, which was further corroborated by high resolution computed tomography. Central bronchiectasis was also observed, which prompted a work-up for ABPA. The child met 7/8 major diagnostic criteria for ABPA. She was then initiated on oral prednisolone that resulted in a marked clinical improvement within a fortnight. Radiological clearance occurred at 3 months with inflation of the middle lobe. ABPA presenting with MLS in a child is yet to be reported. A high index of suspicion is required to establish the diagnosis of ABPA in a child presenting with MLS. This would obviate the invasive investigations usually done to ascertain the cause of MLS.

Omalizumab Treatment for Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis.

Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) is characterized by destructive changes in the airways. Long-term treatment with oral corticosteroids is often required for repeated exacerbations. Because elevated total IgE is a cardinal abnormality of ABPA, omalizumab has been used sporadically to decrease corticosteroid dose or totally replace corticosteroids. The aim of this report is to describe our experience with omalizumab treatment in patients with CF and ABPA. We conducted a review of 6 CF patients with ABPA receiving omalizumab. All patients were treated with oral prednisolone and itraconazole. Omalizumab was started if the patient was not responding to steroid treatment, which was determined according to serum IgE levels and/or clinical findings or depending on if there were side effects caused by steroid treatment. The mean age of patients at the beginning of omalizumab treatment was 16.1 years. One patient had a new diagnosis of ABPA; however, the others had the first to third exacerbation when treated with omalizumab. The mean duration of ABPA by the time that treatment with omalizumab started was 13 ± 12.4 months (range = 2-29 months). With omalizumab treatment, IgE levels were decreased in all patients, and Aspergillus-specific IgE levels were decreased in 4 patients; however, FEV1(% predicted) improved only in 2 patients who had mild disease. Corticosteroids were reduced in the first, second, and third months of omalizumab treatment in 2, 1, and 3 patients, respectively. In 2 patients, steroid treatment was stopped. None of the patients suffered from side effects of omalizumab. The mean duration of omalizumab treatment was 12.5 months (range = 6-18 months). This study showed steroid-sparing effect, decreasing IgE levels, and improvement in respiratory symptoms in 6 CF patients with omalizumab treatment. Although this is a small sample of the population, omalizumab may be an alternative therapy for ABPA in CF patients who fail to respond to systemic corticosteroids or have serious adverse effects.

New Commercially Available IgG Kits and Time-Resolved Fluorometric IgE Assay for Diagnosis of Allergic Bronchopulmonary Aspergillosis in Patients with Cystic Fibrosis.

Allergic bronchopulmonary aspergillosis (ABPA) is difficult to diagnose; diagnosis relies on clinical, radiological, pathological, and serological criteria. Our aim was to assess the performance of two new commercially available kits and a new in-house assay: an Aspergillus fumigatus enzyme-linked immunosorbent assay (ELISA) IgG kit (Bordier Affinity Products), an Aspergillus Western blotting IgG kit (LDBio Diagnostics), and a new in-house time-resolved fluorometric IgE assay (dissociation-enhanced lanthanide fluorescent immunoassay, or DELFIA) using recombinant proteins from an Aspergillus sp. recently developed by our laboratory for ABPA diagnosis in a retrospective study that included 26 cystic fibrosis patients. Aspergillus fumigatus-specific IgG levels measured by a commercial ELISA kit were in accordance with the level of precipitins currently used in our lab. The ELISA kit could accelerate and help standardize ABPA diagnosis. Aspergillus fumigatus-specific IgE levels measured by ImmunoCAP (Phadia) with A. fumigatus M3 antigen and by DELFIA with a purified protein extract of A. fumigatus were significantly correlated (P < 10(-6)). The results with recombinant antigens glucose-6-phosphate isomerase and mannitol-1-phosphate dehydrogenase were encouraging but must be confirmed with sera from more patients. The DELFIA is an effective tool that can detect specific IgE against more fungal allergens than can be detected with other commercially available tests.

Molecular-based allergy diagnosis of allergic bronchopulmonary aspergillosis in Aspergillus fumigatus-sensitized Japanese patients.

Distinguishing between patients with allergic bronchopulmonary aspergillosis (ABPA) and Aspergillus fumigatus (Af)-sensitized asthmatic patients without ABPA is sometimes difficult owing to the IgE-cross-reactivity between Af and other fungal allergens. To establish the usefulness of molecular-based allergy diagnostics using allergen components from Af in distinguishing ABPA from Af-sensitized asthma without ABPA. Sera from Japanese patients with ABPA (n=53) and Af-sensitized asthma without ABPA (n=253) were studied. The levels of IgE and IgG antibodies to allergen components from Af and IgE antibodies to different fugal allergen extracts were measured by ImmunoCAP. Comorbid atopic dermatitis (AD) was taken into consideration in the sensitization profile analysis. Patients with ABPA possessed significantly higher levels of IgE antibodies to Asp f 1, and Asp f 2 than asthmatic patients without ABPA. The areas under the receiver operating characteristic curves for the levels of IgE to Asp f 1 and Asp f 2 as diagnostic markers of ABPA were 0.75 and 0.78, respectively. The presence of IgE positivity to Asp f 1 and/or Asp f 2 resulted in increased sensitivity while losing little specificity. Comorbid AD was associated with higher levels of IgE to Asp f 6 (manganese superoxide dismutase from Af, a ubiquitous pan-allergen in fungi) and low but positive levels of IgE to other Af-components, which hampered the serological discrimination of ABPA. The levels of IgE to Asp f 1 and/or Asp f 2 can effectively differentiate ABPA from Af-sensitized asthma, suggesting that the amounts of IgE specific for these molecules are markers for genuine Af-sensitization in ABPA. However, comorbid AD must be taken into consideration in the interpretation of high IgE to Asp f 6. Establishing of IgE-sensitization profiles using panel of Af-allergen components provides valuable information for distinguishing genuine vs. cross-reactive sensitization in Af-sensitized patients.

Development of chronic pulmonary aspergillosis in adult asthmatics with ABPA

BackgroundChronic pulmonary aspergillosis (CPA) is an occasional complication of allergic bronchopulmonaryaspergillosis (ABPA) but the transition is poorly understood. MethodsAll patients referred to the UK's National Aspergillosis Centre with CPA between May 2009 and June 2012 were screened with serum total IgE and anti-Aspergillus IgE for a dual diagnosis of ABPA and CPA. Those patients suspected of having both conditions were re-evaluated and their imaging reviewed. ResultsOf 407 referred patients, 42 screened positive and 22 were confirmed as having both ABPA and CPA. Asthma was present from early childhood in 19 (86%), the median interval between ABPA and onset of CPA was 7.5 years; one patient developed ABPA and CPA simultaneously. Aspergillus IgG levels varied from 23 to 771 mg/L, median 82 mg/L. All 22 patients had bronchiectasis. In patients with ABPA, CT typically demonstrated varicose or cystic bronchiectasis primarily affecting segmental and proximal subsegmental upper lobe bronchi. Other findings included mucoid impaction and centrilobular nodules. Radiological changes associated with CPA included pleural thickening which was often bilateral and accentuated by adjacent hypertrophied extrapleural fat, upper lobe volume loss, thick walled apical cavities, some of which contained aspergillomas, and cavitating pulmonary nodules. CPA secondary to ABPA has more subtle radiological appearances than when due to other underlying diseases. ConclusionsCPA may complicate ABPA and have distinct radiology features, in addition to bronchiectasis. A novel biomarker is required to anticipate this serious complication, as current serology is not specific enough.

Vitamin D supplementation decreases Aspergillus fumigatus specific Th2 responses in CF patients with aspergillus sensitization: a phase one open-label study.

BackgroundPatients with cystic fibrosis (CF) complicated by allergic bronchopulmonary aspergillosis (ABPA) are vitamin D deficient and in vitro treatment with 1,25 (OH)2 vitamin D3 of CD4+ cells from CF patients with ABPA decreases Aspergillus fumigatus(Af)-induced Th2 responses. This Phase I clinical trial investigated the safety and effectiveness of daily vitamin D3 supplementation in CF patients with ABPA to reduce allergic responses and ABPA symptoms, and increase serum vitamin D levels.MethodsSeven patients ages 12 years and older with a clinical diagnosis of CF and ABPA with current evidence of Af sensitization received 4000 IU vitamin D3 (cholecalciferol) daily for 24 weeks. The primary outcome of the study was safety followed by the Aspergillus induced IL-13 response in CD4+ T cells to test the hypothesis that vitamin D supplementation is safe and reduces Aspergillus induced IL-13 responses in CD4+ T cells. Secondary outcomes included total IgE, Aspergillus- specific IgE, vitamin D levels, FEV1, urinary calcium/creatinine ratio, and cytokine production by Aspergillus-stimulated peripheral blood T cells.ResultsSix months of vitamin D3 supplementation resulted in significant increases in serum 25-(OH) vitamin D level, and the treatment was well tolerated without evidence of vitamin D toxicity or hypercalcemia. There were no serious adverse events. Daily vitamin D supplementation led to significantly decreased Aspergillus induced IL-13 responses between the baseline visit and that at 24 weeks (p = 0.04). Aspergillus-specific IgE level was also significantly decreased after 8 (p = 0.035) and 24 weeks of daily vitamin D supplementation (p = 0.04).Conclusions4000 IU vitamin D3 daily over a 24-week period is well tolerated in CF patients with a history ABPA and current evidence of Th2 immunity to Af. . Daily vitamin D supplementation was associated with reduced Aspergillus induced IL-13 responses from peripheral. . CD4+ T cells and Aspergillus-specific IgE levels, as well as increased serum vitamin D levels. This treatment was well tolerated and the study supports further investigation of the use of vitamin D supplementation in Th2 mediated diseases.Trial registrationThis trial was registered at www.clinicaltrials.gov as NCT01222273.

EPS02.6 Rising prevalence of allergic bronchopulmonary aspergillosis (ABPA) in CF – an unforeseen result of climate change?

Objectives Aspergillus-related lung disease is an important complication of pulmonary disease in CF patients, leading to worsening symptomatology and lung function and we had the clinical impression that its incidence is increasing. Although ABPA is quoted at 5–15%, we wished to identify the true rate of Aspergillus sensitivity in our adult CF population and assess how this may have changed over time. Methods We measured Aspergillus specific IgG in 282 adult CF patients, identifying those with values above the normal range (40 mg/ml) and compared these to our previous study in 202 patients reported in 2009. We also identified patients with a clinical diagnosis of ABPA and compared this to the quoted prevalence in the wider CF population. Results 152 patients (54%, mean age 27 years [range 18–69], 89 male) had a raised specific IgG level, compared to 84 (42%, 29 years [20–52], 45 male) in 2009. Currently, 48 [32%; 26 male, 29 years, (18–57 years), 17% of our total CF cohort] have a diagnosis of ABPA, higher than the quoted prevalence. Conclusion We are seeing an increasing proportion of CF patients with raised immunological markers to Aspergillus with time. This suggests increased exposure to Aspergillus , perhaps as a result of the wetter climate produced in the UK by climate change and in turn indicates that ABPA is and will be a more frequently occurring complication in CF patients.

24 Basophil Activation Test may facilitate ABPA diagnosis in CF patients

Objective Diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) complicating cystic fibrosis (CF) remains problematic. As Basophil Activation Test (BAT) has been applied on the diagnosis of many Th2 mediated conditions, it could be a promising method for ABPA diagnosis. Methods We present 21 cases of patients with probable ABPA who did not fulfill the minimal diagnostic criteria. BAT was performed when patients' clinical and immunological status was deteriorated and they were followed up for 6 years. Results Fifteen patients (71.4%) were male and seven patients (33.3%) were homozygous for DF508 mutation. Twelve patients developed ABPA during the study period. In these patients the median CD63 was 71.89% while the median CD203 was 78.96%. The median time of diagnosis was ten months. In the group of nine patients who have not fulfilled the diagnostic criteria up to present, the median CD63 was 24.57% and the median CD203 was 60.74%. Differences were found statistically significant (p = 0.041 and p = 0.049 respectively). Conclusion BAT could be considered as an additional criterion for ABPA diagnosis, particularly in patients who do not fulfill the minimal diagnostic criteria.

23 Seasonal variation in Aspergillus specific antibody levels – does weather influence exposure?

Objective ABPA is an important complication of pulmonary disease in CF patients, quoted as occurring in 5–15% of patients. We speculated that environmental exposure varies with weather conditions and so sought to look for variations in Aspergillus specific IgG level according to time of year and seasonality. Methods Of 282 adult CF patients, we selected the 152 (54%, mean age 29 years [range 18–69], 89 male) with heightened Aspergillus sensitivity ( Aspergillus specific IgG levels above the normal range (40 mg/ml)) and recorded these per month for the years 2009–2014. The exercise was repeated for those 48 patients with a clinical diagnosis of allergic bronchopulmonary aspergillosis (mean age 29 years [18–57], 26 male; 32% of those with raised specific IgG). Results Aggregated results showed a trend towards higher Aspergillus specific IgG levels in the Spring months in both groups, when the weather in this part of the UK tends to be mild and wet. Conclusion The increased sensitivity to Aspergillus in CF patients in the mild and wet Spring months suggest that these conditions favour the growth of Aspergillus fumigatus . This would suggest that we might see a rise in symptomatic ABPA at this time of year, and explain why we have higher than quoted proportion of CF patients with ABPA.

Asthme et Aspergillus

There is an association between sensitisation to moulds, uncontrolled fungal infections and bad asthma control. The diagnosis of allergic broncho-pulmonary aspergillosis (ABPA) is based on three indispensible criteria: a reversible ventilatory disorder or mucoviscidosis, a total IgE > 1000 UI / ml ml and a specific Aspergillus IgE> 0,35 KUA /l, associated with two of the following: a positive Aspergillus precipintin test, a characteristic CT-scan and a blood eosinophilia > 500 cells / μ moL (without taking corticoids). The treatment is based on reduction of the local inflammation by systemic corticoids and on the decrease of mycelial proliferation during exacerbations by Itraconazole. The prevalence of severe asthma with fungal sensitisation (SAFS) is about 30 % and the use of azoles should be time-limited and reserved for refractory situations in severe asthma.

Allergic Bronchopulmonary Aspergillosis Presenting as Recurrent Mass-like Consolidation.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitive disease showing various radiographic and clinical manifestations. Its clinical course has not been fully understood. Here I describe a case of a 23-year-old immunocompetent man with frequently relapsing ABPA. He was asthmatic. He visited our hospital because of a chronic cough. Laboratory examination showed eosinophilia with increased total and Aspergillus-specific IgE as well as positive skin reaction to Aspergillus fumigatus. Radiologic feature was a dense consolidation. Histology showed organizing pneumonia with eosinophilic infiltration. On the diagnosis of ABPA, he was treated with systemic steroid and itraconazole. Although treatment response was excellent, he suffered from recurrent ABPA three times thereafter in the form of fleeting mass-like consolidation.

Over Diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) Cases as Pulmonary Tuberculosis

Over Diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) Cases as Pulmonary Tuberculosis

An Audit of the Management of ABPA in CF patients at Alder Hey Children’s Hospital

Background : Allergic bronchopulmonary aspergillosis (ABPA) is a persistent problem for many cystic fibrosis (CF) patients. It is a challenging condition to diagnose and manage. Aim: The CF team at Alder Hey Children’s Hospital aimed to assess how consistently and effectively they were managing the condition. A diagnosis and management monitoring tool was used to systematically draw data for auditing. Methods : Out of 87 patients under the care of the CF team, 20 had previously been diagnosed with ABPA. 60% had 4 out of the 4 minimal diagnostic criteria. 75% grew cultures positive for A. fumigatus at some point since their diagnosis of ABPA. All patients had received prednisolone therapy at some point since diagnosis, with 7 patients receiving the maximum starting dose of 40 mg and 1.29 mg/kg for those below maximum dose. 14 patients were prescribed antifungal therapy. 5 patients had levels ordered when they started the therapy, 5 had levels ordered between 45 and 1149 days after prescription, and 3 have had no levels ordered to date. A second audit was performed one year later to complete the audit cycle. Results : This cohort of patients had a much higher prevalence of ABPA than the general CF population. Discussion : Research into the relationship between ABPA exacerbation and concurrent infections or antibiotic therapy could help identify risk factors for developing an exacerbation. There should be discussions about how to improve the consistency in initial dosing of prednisolone, considering guidelines. Conclusion : There should be more itraconazole levels taken to ensure safety and effectiveness of antifungal therapy.

Allergic Bronchopulmonary Aspergillosis

There remains a lack of agreement on diagnostic criteria and approaches to treatment of patients with allergic bronchopulmonary aspergillosis (ABPA). The results of a survey of American Academy of Allergy, Asthma, & Immunology members regarding these 2 issues are presented and compared for concordance with published recommendations. The literature was reviewed for pertinent reports, and an electronic survey was conducted of American Academy of Allergy, Asthma, & Immunology members and fellows regarding diagnostic criteria, numbers of patients evaluated for ABPA, and treatment approaches. From 508 respondents to the survey sent to 5155 US physicians in the American Academy of Allergy, Asthma, & Immunology database of members and fellows, 245 health professionals (48%) had treated at least 1 patient with ABPA in the previous year. For the diagnosis of ABPA, there was a difference in the threshold concentration of total serum IgE because 44.9% used ≥417 kU/L, whereas 42.0% used ≥1000 kU/L. Analysis of these findings suggests that ABPA might be underdiagnosed. With regard to pharmacotherapy, oral steroids were recommended for 97.1% of patients and oral steroids plus inhaled corticosteroids plus antifungal agent were used with 41.2% of patients. The armamentarium for treatment of ABPA includes oral corticosteroids as the initial treatment with inhaled corticosteroids used for management of persistent asthma. Azoles remain adjunctive. Published experience with omalizumab has been limited.

Diagnosis of allergic bronchopulmonary aspergillosis: a case-based approach.

Allergic bronchopulmonary aspergillosis is a pulmonary disease occurring in patients with asthma or cystic fibrosis, consequent to a dysregulated immune response to inhaled Aspergillus conidia. The usual presentation is with poorly controlled asthma. Patients may also present with expectoration of mucus plugs, hemoptysis, constitutional symptoms and radiological opacities. Patients may experience smoldering lung destruction despite well-controlled asthma. With emerging data, the diagnostic criteria transcribed by an International Expert Committee in 2013 are the latest evidence-based guidelines. Herein, we utilize a case-based approach to elaborate on the diagnosis of this disease. The review intends to provide a lucid understanding of the diagnostic process for the expert as well as the primary physician, involved in management of this enigmatic disorder.

Cut-off values of serum IgE (total and A.fumigatus -specific) and eosinophil count in differentiating allergic bronchopulmonary aspergillosis from asthma.

The cut-off values of immunological tests employed in diagnosis of allergic bronchopulmonary aspergillosis (ABPA) have never been validated. Herein, we compare the immunological findings in patients with ABPA and asthma using receiver operating characteristic analysis. Consecutive asthmatic subjects underwent all the following investigations: Aspergillus skin test, IgE levels (total and A.fumigatus-specific), Aspergillus precipitins, eosinophil count, chest radiograph and CT chest. There were 372 subjects (179 men, mean age 35.9years) with a mean asthma duration of 8years. ABPA was diagnosed in 76 patients (64 bronchiectasis, 12 without bronchiectasis). ABPA was separated from asthma using the best cut-off values of total IgE, A.fumigatus IgE and total eosinophil count of2347IUml(-1) , 1.91kUAl(-1) and 507 cells per μl respectively. The sensitivity/specificity of these parameters were 87/81%; 99/87%; and, 79/76% respectively. The corresponding AUC values were 0.95, 0.90 and 0.82 respectively. The combination of these three tests at the aforementioned cut-offs provided 100% specificity. Our study provides evidence-based cut-off values of IgE (total and A.fumigatus-specific) and eosinophil counts in differentiating ABPA from asthma. As this is a single centre retrospective study, further studies from different centres are required, as these values could vary by ethnicity and environmental exposure.

Multi-country estimate of different manifestations of aspergillosis in cystic fibrosis.

Aspergillus spp. can lead to allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitisation and Aspergillus bronchitis in CF. The relative frequencies of these entities have recently been ascertained in a large UK adult CF cohort. We have used this data to estimate the burden of aspergillosis and ABPA cases in adult CF patients in 30 countries reporting CF. National and international CF registry data was accessed and assessed for completeness and age distribution. Published proportions of ABPA (17.7%), Aspergillus sensitisation (14.6%) and Aspergillus bronchitis (30%) in CF were applied to those >18 years and compared with notified ABPA cases. Of the 76,201 estimated CF patients worldwide (not including India), 37,714 were >18 years. The proportion of adults to children varied from 63% in Norway to 20% in Brazil. ABPA caseload in adults is anticipated to be 6,675 cases of which only 2,221 cases (33%) are currently recorded, indicating substantial underdiagnosis. The ABPA diagnosis rate compared with estimated rates varies by country from 101% (France) to 14.5% (Greece), although genetic variation could account for genuine differences compared with the UK. Aspergillus bronchitis is not currently recognised or recorded in CF registries but there are an anticipated 10,988 adult cases. Aspergillus sensitisation, associated with increased bronchiectasis and reduced FEV1, affects an anticipated 5,506 patients without ABPA or Aspergillus bronchitis. Together ABPA and Aspergillus bronchitis are estimated to affect 17,989 adults, 47.7% of the adult CF population. ABPA also occurs in children and teenagers and 984 cases were documented in registries. Diagnosed ABPA rates by age were available for the ECFS registry, USA, UK, Ireland, Belgium and Netherlands. The rate was <1% under 4 years, and increased throughout childhood and adolescence, with marked variation between countries. Newly published diagnostic criteria and methods should facilitate better recognition of aspergillosis in CF, allowing better CF disease control.

Allergic aspergillosis and the antigens of Aspergillus fumigatus.

Incidence of fungal infections has increased alarmingly in past few decades. Of the fungal pathogens, the Aspergillus fumigatus has been a major cause of allergic bronchopulmonary aspergillosis (ABPA) which has five main stages--the acute, remission, exacerbation, glucocorticoid dependent and fibrotic stage. The diagnosis of ABPA remains difficult due to its overlapping clinical and radiological features with tuberculosis and cystic fibrosis. From past few decades, the crude fractions of A. fumigatus have been used for immunodiagnosis of ABPA. Most of the detection kits based on crude fractions of A. fumigatus are quite sensitive but have low specificity. Till date 21 known and 25 predicted allergens of A. fumigatus have been identified. Of these allergens, only five recombinants (rAsp f1-f4 and f6) are commercially used for diagnosis of allergic aspergillosis. Remaining allergens of A. fumigatus have been restricted for use in specific diagnosis of ABPA, due to sharing of common antigenic epitopes with other allergens. Complete sequencing of A. fumigatus genome identified 9926 genes and the reports on the proteome of A. fumigatus have shown the presence of large number of their corresponding proteins in the pathogen. The analysis of immunoproteomes developed from crude fractions of A. fumigatus by IgG/IgE reactivity with ABPA patients and animal sera have identified the panel of new antigens. A brief description on the current status of A. fumigatus antigens is provided in this review. The implementation of advance recombinant expression and peptidomic approaches on the A. fumigatus antigens may help in the selection of appropriate molecules for the development of tools for more specific early diagnosis of ABPA, and desensitization therapies for patients of allergic disorders.

Aspergilosis broncopulmonar alérgica

La aspergilosis broncopulmonar alérgica es una enfermedad de progresión lenta, producida por la hipersensibilidad al hongo Aspergillus fumigatus cuando invade la vía aérea. Por lo general afecta a pacientes asmáticos y con fibrosis quística. Comunicamos el caso de un paciente de 20 años de edad, estudiante, ganadero y agricultor, con un cuadro respiratorio crónico. Luego del análisis de sus síntomas y de estudios complementarios, llegamos al diagnóstico de aspergilosis broncopulmonar alérgica.