Allergic bronchopulmonary aspergillosis
ABPA occurs in patients with asthma (1%-2% of patients with asthma) or cystic fibrosis (2%-15% of patients with cystic fibrosis). Men and women are affected equally. Most patients are young adults.
Patients present primarily with worsening of asthma symptoms. Some patients may have other symptoms including productive cough, fever, or hemoptysis. Recurrent exacerbations are common.
Central bronchiectasis can be seen on CT scan of the chest, particularly affecting airways in the central half to two-thirds of the chest.
Treatment includes systemic corticosteroids and sometimes antifungal medication.
B44.81 – Allergic bronchopulmonary aspergillosis
37981002 – Allergic bronchopulmonary aspergillosis
Differential Diagnosis & Pitfalls
- Chronic bronchitis
- Cystic fibrosis
- Bronchocentric granulomatosis – diagnosis is made by lung biopsy
- Eosinophilic granulomatosis with polyangiitis – many (but not all) patients will have antineutrophil cytoplasmic antibodies
- Chronic eosinophilic pneumonia – bronchoalveolar lavage shows eosinophilia
- Acute eosinophilic pneumonia – presentation usually more acute than ABPA; patients have hypoxia and diffuse pulmonary infiltrates on presentation
- Pulmonary eosinophilia due to drugs or toxins
- Hypereosinophilic syndrome – patients have peripheral eosinophilia
- Tropical pulmonary eosinophilia – in patients with lymphatic filariasis