Allergic bronchopulmonary aspergillosis — ABIM Board MCQ

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EasyPulmonary/Critical CareAllergic bronchopulmonary aspergillosisABIM Board

A 36-year-old woman with asthma has recurrent wheezing, expectoration of brown mucus plugs, and fleeting pulmonary infiltrates. Her peripheral blood eosinophil count is 1,100/mm3, total serum IgE is 1,850 IU/mL, and Aspergillus-specific IgE is positive. Chest CT shows central bronchiectasis. Which of the following is the most likely diagnosis?

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Correct answer: B — Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis is an Aspergillus hypersensitivity disorder that occurs most often in patients with asthma. The decisive findings are Aspergillus sensitization, markedly elevated total IgE, eosinophilia, brown mucus plugs, transient pulmonary opacities, and central bronchiectasis. Eosinophilic granulomatosis with polyangiitis can cause asthma and eosinophilia but usually has systemic vasculitic features such as neuropathy, purpura, renal disease, or sinus disease. Chronic eosinophilic pneumonia typically causes peripheral airspace opacities and does not explain Aspergillus sensitization with central bronchiectasis. Invasive pulmonary aspergillosis occurs primarily in markedly immunocompromised patients and more often produces nodules, infarcts, or cavitation. Hypersensitivity pneumonitis is exposure-related and typically causes diffuse centrilobular or ground-glass abnormalities rather than this IgE-mediated bronchiectatic syndrome.

Reference: Agarwal R, et al. Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. European Respiratory Journal. 2024;63(4):2400061. https://pubmed.ncbi.nlm.nih.gov/38423624/