Chronic pulmonary aspergillosis may cause eosinophilic granulomatosis with polyangiitis via allergic bronchopulmonary aspergillosis

Abstract

An 84-year-old man visited our hospital with a prolonged productive cough. Chest computed tomography showed a thick wall cavity and bilateral consolidations. Laboratory findings revealed peripheral blood eosinophilia, increased total IgE and elevated myeloperoxidase anti-neutrophil cytoplasmic antibody. Specific IgE and IgG antibodies and an immediate skin reaction against Aspergillus showed positive results. The histological findings of the lung parenchyma were compatible with eosinophilic pneumonia and bronchial biopsy showed eosinophilic vasculitis. Bronchoalveolar lavage fluid culture yielded Aspergillus fumigatus. These results met the diagnosis criteria for both allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatosis with polyangiitis (EGPA). This case thus suggests that A. fumigatus might be a pathogen common to both diseases, and prolonged exposure to A. fumigatus in some patients with ABPA may promote progression to EGPA.

Coexistence of Eosinophilic Granulomatosis With Polyangiitis and Allergic Bronchopulmonary Aspergillosis: A Fascinating Relationship

“…Eight cases of coexisting EGPA and ABPA were included in this paper, bringing the total number of cases reviewed to nine (Table 1). Instances of concurrent EGPA and ABPA have been reported in the literature [10][11][12][13][14][15]. EGPA may precede or follow ABPA, and they can be diagnosed concurrently.…”

“…Some diagnostic criteria are common, and differential diagnosis is recommended. Several reports described the sequential occurrence of ABPA and EGPA, or vice versa [10][11][12][13][14][15]. How one established disease may predispose to the other is unknown, but it may include eosinophil recruitment by T helper 2 (Th2)-driven inflammation predisposing to fungal colonization and subsequent hypersensitivity [15].…”

Combined allergic bronchopulmonary mycosis and eosinophilic granulomatosis with polyangiitis: A case report and literature review

“…Considering long-term exposure to allergens may activate the immune response and lead to systemic eosinophilic vasculitis, some scholars believe that both ABPM and EGPA belong to adult-onset eosinophilic respiratory diseases and share common immune and pathological processes [ 2 ]. There were several cases of coexistence of ABPM and EGPA have been reported [ [3] , [4] , [5] , [6] , [7] , [8] , [9] ], in some cases ABPM was diagnosed prior to EGPA, in some cases EGPA was diagnosed prior to ABPM, and in some cases diagnosed simultaneously.…”

“… 1205 12200 – A, B, MP, N −2 years GS 6 [ 8 ] 47/male Aspergillus fumigatus NA 1000 + A, B, M, MP, SD 6 years GS 7 [ 6 ] 61/male Aspergillus sp. 7610 1880 – A, B, N, S, SD −4 years GS, AZA, ITCZ 8 [ 9 ] 84/male Aspergillus fumigatus 1510 1401 + A, L, SD 0 GS, ITCZ 9 [ 7 ] 72/male Aspergillus fumigatus NA 7100 + A, B, M, N, SD 3 months GS, AZA 10 27/female Aspergillus sp. 280 1750 – A, B, MP, SD 0 GS, ITCZ A, asthma; AZA, azathioprine; B, bronchiectasis; C, cardiovascular involvement; CTX, cyclophosphamide; G, gastrointestinal involvement; GS, glucocorticoid; ITCZ, itraconazole; L, lung involvement; M, muscle involvement; MP, mucus plugs; N, nervous system involvement; NA, not available; R, renal involvement; S, skin involvement; SD, sinus disease.…”

Combined Allergic bronchopulmonary mycosis and Eosinophilic Granulomatosis with Polyangiitis: A Case Report and Literature Review

“…Considering long-term exposure to allergens may activate the immune response and lead to systemic eosinophilic vasculitis, some scholars believe that both ABPM and EGPA belong to adult-onset eosinophilic respiratory diseases and share common immune and pathological processes(2). There were several cases of coexistence of ABPM and EGPA have been reported (3)(4)(5)(6)(7)(8)(9), in some cases ABPM was diagnosed prior to EGPA, in some cases EGPA was diagnosed prior to ABPM, and in some cases diagnosed simultaneously.…”