Allergic Bronchopulmonary Aspergillosis Presenting as Lobar or Total Lung Collapse

Abstract

Allergic Bronchopulmonary Aspergillosis presenting as lobar or total lung collapseAlergiczna aspergiloza oskrzelowo-płucna w postaci niedodmy płucThe authors declare no financial disclosure Abstract Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a T-helper cell 2 (Th2) mediated hypersensitive lung disorder in response to Aspergillus that usually affects asthmatic and cystic fibrosis (CF) patients. ABPA rarely presents as lung collapse and such kind of presentation is very rare in non asthmatic patients. We are presenting a series of three cases in which ABPA presented as lobar or total lung collapse. ABPA presenting as opaque hemithorax is a rarity with only a few of them reported in the literature. Case series -the first case described is a 45-year non-smoker with history suggestive of bronchial asthma and on chest radiological examination was found to have opaque right hemithorax. The second case is of 62-year non-smoker non-asthmatic patient who presented to us as left lung collapse. The last case is of middle lobe collapse in asthmatic male. All cases ultimately were proved to be having ABPA and after treatment showed marked clinical and radiological improvement. Conclusions: The present case series highlights the need for aggressive approach in diagnosing this treatable condition in cases presenting as segmental or total lung collapse. The condition has a good prognosis if detected early.

N -Chlorotaurine Exhibits Fungicidal Activity against Therapy-Refractory Scedosporium Species and Lomentospora prolificans

“…The contraindication of lung trans- plantation is discussed for patients with a Scedosporium-colonized lower respiratory tract, as it was reported in cases of disseminated scedosporiosis (52,53). The role of fungi in exacerbations of chronic bronchitis, lung infections, and as allergic agents in the respiratory tract of cystic fibrosis patients was highlighted recently (54,55).…”

Case Report: Allergic Bronchopulmonary Aspergillosis Revealing Asthma

“…The diagnosis of ABPA is confirmed when the case presentation meets the criteria established in 2013 by the ABPA Working Group of the International Society for Human and Animal Mycology. If total IgE level are over 1000 IU/mL, two among three criteria are sufficient for establishing the diagnosis of ABPA: positive serum precipitins/Aspergillus fumigatus IgG, eosinophil count >500 cell/L, chest CT consistent with ABPA (mucus impaction, tree-in-bud pattern, centrilobular nodules, mosaic attenuation (31); high attenuation mucus, pathognomonic for ABPA (9,32); segmental, lobar and total lung collapse due to mucus plugs (33)(34)(35); central or peripheral bronchiectasis). Patients with a total IgE levels under 1000 IU/mL, who, otherwise, meet all the remaining criteria are also diagnosed with ABPA (9).…”

“…Furthermore, omalizumab has also proven its efficacy in ABPA, compared to long-term glucocorticoids and it can be administered even in cases with high level of IgE (42). In the case of acute lung collapse, broncho-alveolar lavage during rigid or flexible bronchoscopy helps the lung re-expansion and significant improvement of ABPA symptoms (33,43). For patients with thick sputum, chest physiotherapy and nebulized hypertonic saline solution improve the symptoms (44,45).…”

Allergic bronchopulmonary aspergillosis misdiagnosed as smear negative pulmonary tuberculosis; a retrospective study from Pakistan

“…Cough, fever and hemoptysis are the presenting complaints in both entities. According to a study, almost 31% of patients with ABPA had hemoptysis as primary complaint; [ 5 ]. Similarly, a study on TB revealed that hemoptysis was a symptom in about 79.2% of patients [ 6 ].…”