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ABPA — RACP Paediatrics MCQ

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HardRespiratoryABPARACP Paediatrics

A 9-year-old with poorly controlled asthma develops a new productive cough with brownish sputum plugs. Total IgE is markedly elevated (2500 IU/mL). Eosinophil count is 1.5 × 10⁹/L. Aspergillus-specific IgE is strongly positive. CT chest shows central bronchiectasis with mucoid impaction. What is the most likely diagnosis?

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Correct answer: B — Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) should be considered in asthmatic or CF patients with worsening symptoms, elevated total IgE, eosinophilia, positive Aspergillus-specific IgE/IgG, and central bronchiectasis. Treatment is with systemic corticosteroids (prednisolone) and itraconazole.

Reference: RCH Melbourne – 2023 – CF CPG; Australian Therapeutic Guidelines – 2024 – Respiratory