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Allergic bronchopulmonary aspergillosis — SCE Respiratory MCQ

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ModerateRespiratory infectionsAllergic bronchopulmonary aspergillosisSCE Respiratory

A 39-year-old man with asthma has worsening wheeze, cough with brown plugs and fleeting pulmonary infiltrates. Total IgE is 1,950 IU/mL, Aspergillus-specific IgE is positive and eosinophils are 1.4 × 10^9/L. CT shows central bronchiectasis and mucus plugging. He is not immunocompromised. What is the most likely diagnosis?

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Correct answer: D — Allergic bronchopulmonary aspergillosis

Asthma, very high IgE, Aspergillus sensitisation, eosinophilia and central bronchiectasis indicate ABPA. Invasive aspergillosis is mainly seen in significant immunosuppression and presents differently. Brown mucus plugs and fleeting infiltrates are classic clues.

Reference: BTS Bronchiectasis Guideline; ISHAM ABPA guidance