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Allergic bronchopulmonary aspergillosis — SCE Respiratory MCQ

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ModerateAsthmaAllergic bronchopulmonary aspergillosisSCE Respiratory

A 35-year-old woman with asthma has fleeting pulmonary infiltrates, brown mucus plugs and worsening wheeze. Total IgE is 1,920 IU/mL, Aspergillus-specific IgE is positive and eosinophils are 1.3 x 10^9/L. CT shows central bronchiectasis. What is the most likely diagnosis?

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Correct answer: C — Allergic bronchopulmonary aspergillosis

Asthma, high total IgE, Aspergillus sensitisation, eosinophilia, mucus plugging and central bronchiectasis are typical of allergic bronchopulmonary aspergillosis. Invasive aspergillosis is usually seen in profound immunosuppression and chronic pulmonary aspergillosis usually complicates cavities. EGPA can produce asthma and eosinophilia but Aspergillus sensitisation with central bronchiectasis makes ABPA more likely.

Reference: BTS Bronchiectasis Guideline 2019; ISHAM ABPA Guidelines