[A clinical analysis of 23 cases of allergic bronchopulmonary aspergillosis]

To describe the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA).

The clinical presentations, serologic results, lung function data, chest radiology and the results of treatment of 23 patients with ABPA in Peking Union Medical College Hospital were retrospectively analyzed.

There were 11 males and 12 females, with a mean age of (34.0 +/- 13.2) yrs. Tuberculosis, pneumonia, lung cancer and Wegener's granulomatosis were initially diagnosed in 12, 3, 2 and 1 cases respectively. Cough was present in all patients and sputum production in 22 cases, wheeze in 18, sputum plugs in 16, fever in 15 (high degree of fever in 4), hemoptysis in 12, chest pain/backache in 8 and weight loss in 7 cases. Forced expired volume in one second (FEV(1)) was (54.7 +/- 24.1)% predicted, and FEV(1)/forced vital capacity (FVC) was (62.5 +/- 11.9)%. The FEV(1) reversibility was found in 56% (9/16) of the patients. Chest CT were performed in 22 cases. Patchy infiltrations were present in 21, central bronchiectasis in 17, nodular opacities in 9, mucoid impaction (glover-finger/band linear opacities) in 6, consolidation in 5, and mediastinal adenopathy in 11 cases, while 17 cases presented fleeting infiltrations. Twenty-two patients were treated with prednisone plus itraconazole and 17 patients were followed. The median follow up time was 26.2 months (13 days -19 years). Pulmonary infiltrations relapsed in 9 patients and not appeared for more than 6 years in only one patient.

ABPA was mostly misdiagnosed as tuberculosis. Wheeze is present in almost all patients with ABPA, which can be useful in differentiation from tuberculosis. Obstructive ventilatory defect, peripheral blood eosinophilia, fleeting pulmonary infiltration and central bronchiectasis were features of ABPA. Measurement of total IgE, A.fumigatus-specific IgE levels and immediate cutaneous reaction to A.fumigatus are helpful for confirmation of the diagnosis.