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Allergic bronchopulmonary aspergillosis — SCE Respiratory MCQ

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ModerateAsthmaAllergic bronchopulmonary aspergillosisSCE Respiratory

A 36-year-old man with childhood asthma presents with worsening wheeze, fleeting pulmonary infiltrates and expectoration of brown plugs. FEV1 is 61% predicted with reversibility. Total IgE is 2,400 IU/mL, eosinophils are 1.1 x 10^9/L and CT shows central bronchiectasis with mucus impaction. What is the most likely diagnosis?

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Correct answer: A — Allergic bronchopulmonary aspergillosis

Asthma, very high IgE, eosinophilia, central bronchiectasis and mucus plugging are typical of allergic bronchopulmonary aspergillosis. Chronic pulmonary aspergillosis usually complicates cavities and causes raised Aspergillus IgG rather than central bronchiectasis with high IgE. EGPA would usually add systemic vasculitic features, and hypersensitivity pneumonitis gives small-airway and interstitial features rather than this asthma-centred phenotype.

Reference: BTS/NICE/SIGN Asthma Guideline NG245; BTS Bronchiectasis Guideline