Association of pulmonary aspergilloma and allergic bronchopulmonary aspergillosis

Montani, David; Zendah, I.; Achouh, L.; Dorfmüller, Peter; Mercier, Olaf; Garcia, Gilles; Humbert, Marc

doi:10.1183/09059180.00004810

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…Concurrent ABPA and aspergilloma is likely to increase the severity of the disease with more frequent exacerbations of asthma and possibly increased risk of haemoptysis [250]. Such patients should be monitored carefully and antifungal therapy or resection of the aspergilloma may be necessary in symptomatic patients [250,251].…”

Section: Pulmonary Aspergillus Overlap Syndromesmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

603

596

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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Section: Pulmonary Aspergillus Overlap Syndromesmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

603

596

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“…Previous studies have reported the outcome of surgical resection for aspergilloma in ABPA patients, due to pneumothorax [ 8 ] and hemoptysis [ 9 , 10 ]. However, only one case involved a report of surgical resection for aspergilloma that contributed to disease control of ABPA; the patient was followed up without ABPA treatment for 6 months after receiving surgical resection for aspergilloma with antifungal therapy [ 11 ], whereas our case was followed up for a number of years.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of allergic bronchopulmonary aspergillosis after adjunctive surgery for aspergilloma: a case report with long-term follow-up

et al. 2018

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BackgroundCoexistence of aspergilloma and allergic bronchopulmonary aspergillosis (ABPA) has rarely been reported. Although the treatment for ABPA includes administration of corticosteroids and antifungal agents, little is known about the treatment for coexisting aspergilloma and ABPA. Furthermore, the impact of surgical resection for aspergilloma on ABPA is not fully understood. Here, we present an interesting case of recurrent ABPA with long-term follow-up after surgical resection of aspergilloma.Case presentationA 53-year-old man with a medical history of tuberculosis was referred to our hospital with cough and dyspnea. Imaging revealed multiple cavitary lesions in the right upper lobe of the lung, with a fungus ball and mucoid impaction. The eosinophil count, total serum immunoglobulin E (IgE), and Aspergillus-specific IgE levels were elevated. Specimens collected on bronchoscopy revealed fungal filaments compatible with Aspergillus species. Based on these findings, a diagnosis of ABPA with concomitant aspergilloma was made. Although treatment with corticosteroids and antifungal agents was administered, the patient’s respiratory symptoms persisted. Therefore, he underwent lobectomy of the right upper lobe, which resulted in a stable condition without the need for medication. Twenty-three months after discontinuation of medical treatment, his respiratory symptoms gradually worsened with a recurrence of elevated eosinophil count and total serum IgE. Imaging revealed recurrent bronchiectasis and cavities with mucoid impaction in the right lower lobe, suggesting relapse of aspergilloma and ABPA. Corticosteroids and antifungal agents were re-administered; aspergilloma improved slightly over a 5-year period, and ABPA remained well controlled with low-dose prednisolone (5 mg/day).ConclusionsWe describe the long-term follow-up outcomes of a patient with concomitant ABPA and aspergilloma, who underwent surgical resection for aspergilloma. Physicians should carefully monitor patients with coexisting ABPA and aspergilloma, as the condition may relapse after remission, even despite surgical resection for aspergilloma. Additionally, surgical resection for aspergilloma could result in resolution of ABPA.

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“…A reduction in Aspergillus colonisation of the airways in ABPA has been noted with itraconazole. The patient reported in this issue of the European Respiratory Review responded well to wedge resection of the aspergilloma and itraconazole post-operatively [23]. A significant reduction in the total IgE level was noted at 5 months and itraconazole was discontinued after 1.5 yrs.…”

mentioning

confidence: 84%

“…In spite of similar immunopathological responses, concomitant occurrence of ABPA and AAS is infrequently reported [19][20][21][22]. In this issue of the European Respiratory Review, MONTANI et al [23] describe a 50-yr-old female with concomitant ABPA and aspergilloma. Even though chronic lung damage appears to provide a favourable milieu for aspergilloma formation, the concomitant occurrence of aspergillomas is rather uncommon in patients with ABPA, even in the presence of cavitation [24,25].…”

mentioning

confidence: 99%

Concurrent allergic bronchopulmonary aspergillosis and aspergilloma: is it a more severe form of the disease?

Shah¹

2010

Eur Respir Rev

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Association of pulmonary aspergilloma and allergic bronchopulmonary aspergillosis

Cited by 10 publications

References 16 publications

Pulmonary aspergillosis: a clinical review

Pulmonary aspergillosis: a clinical review

Recurrence of allergic bronchopulmonary aspergillosis after adjunctive surgery for aspergilloma: a case report with long-term follow-up

Concurrent allergic bronchopulmonary aspergillosis and aspergilloma: is it a more severe form of the disease?

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