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Allergic bronchopulmonary aspergillosis — SCE Respiratory MCQ

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HardAsthmaAllergic bronchopulmonary aspergillosisSCE Respiratory

A 37-year-old woman with long-standing asthma presents with cough, fleeting pulmonary infiltrates and brown mucus plugs. Eosinophils are 1.1 x 10^9/L, total IgE is 2200 IU/mL and Aspergillus fumigatus-specific IgE is positive. CT shows central bronchiectasis with high-attenuation mucus. What is the most likely diagnosis?

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Correct answer: E — Allergic bronchopulmonary aspergillosis

The combination of asthma, very high IgE, Aspergillus sensitisation, eosinophilia and central bronchiectasis is typical of ABPA. Chronic pulmonary aspergillosis usually occurs with cavities or structural lung disease rather than central bronchiectasis with marked IgE elevation. EGPA can cause asthma and eosinophilia but the Aspergillus sensitisation and mucus plugging are much more specific for ABPA.

Reference: BTS Clinical Statement on Aspergillus-related Chronic Pulmonary Disease; ERS ABPA guidance