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ABPA — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsABPASCE Infectious Diseases

A 50-year-old man with advanced COPD on long-term Prednisolone develops Aspergillus fumigatus isolated from three sputum samples. He has a productive cough with brown mucous plugs, peripheral blood eosinophilia (1.5 × 10⁹/L), total IgE 2,500 IU/mL, and Aspergillus-specific IgE positive. CXR shows fleeting pulmonary infiltrates and proximal bronchiectasis. What is the diagnosis?

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Correct answer: B — Allergic bronchopulmonary aspergillosis (ABPA)

The combination of asthma/COPD, peripheral eosinophilia, raised total IgE (>1000), positive Aspergillus-specific IgE/IgG, fleeting pulmonary infiltrates, mucoid impaction (brown plugs), and proximal bronchiectasis is diagnostic of ABPA. This is a hypersensitivity reaction to Aspergillus antigens in the airway — NOT tissue invasion. Treatment is systemic corticosteroids (Prednisolone 0.5 mg/kg taper) plus Itraconazole as a steroid-sparing agent and to reduce fungal burden. Voriconazole and Posaconazole are alternatives.

Reference: NICE 2024 – ABPA; ISHAM 2021 – ABPA working group