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ABPA — RACP Adult Medicine MCQ

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ModerateRespiratoryABPARACP Adult Medicine

A 55-year-old man with asthma presents with worsening dyspnoea, peripheral eosinophilia (8.2 × 10⁹/L), migratory pulmonary infiltrates, and proximal bronchiectasis. Serum total IgE is >1000 IU/mL. Aspergillus-specific IgE and IgG are positive. Skin prick test to Aspergillus is positive. What is the most likely cause of eosinophilia?

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Correct answer: B — Allergic bronchopulmonary aspergillosis

Asthma with eosinophilia, migratory pulmonary infiltrates, proximal bronchiectasis, elevated total IgE (>1000), and positive Aspergillus serology/skin testing is ABPA. It is a hypersensitivity reaction to Aspergillus colonising the airways. Treatment is systemic corticosteroids (prednisolone) plus itraconazole as steroid-sparing adjunct. Omalizumab may be considered in refractory cases.

Reference: Australian Asthma Handbook – 2024 – ABPA; ISHAM 2024