A case of occupational allergic bronchopulmonary aspergillosis unique to Japan

A 15-year-old female was diagnosed in 1980 as having allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus fumigatus based on Rosenberg and Patterson's criteria for the disease. The patient is the eldest daughter of a family of domestic brewers of soy sauce and bean paste in a small village, an occupation unique to Japan. The brewing process involved the use of Aspergillus oryzae as a fermenting agent. The patient had experienced episodic wheezing and pulmonary infiltrates during the same seasons in the previous three years, corresponding to the time of the highest A oryzae spore concentrations in the living area, suggesting high exposure to the Aspergillus spores in the aetiology of her exacerbations. She had a prominent family history of atopy and was demonstrated to be sensitive to a variety of aeroallergens in addition to A fumigatus. She was treated effectively by bronchial toiletting via broncho-fibrescope and theophylline medication until April 1981, when she moved to another city. During her life there, chest X-rays repeatedly showed abnormal shadows, and she was treated with inhalations of amphotericin B and bronchial toiletting several times at a hospital. She returned to her home town after seven years in April 1988 and visited the hospital to check her condition. Although she had been away from heavy exposure to A oryzae spores for seven years, precipitins to the culture medium of A oryzae were demonstrated to be far more prominent than those to A fumigatus antigen. Although her family had been exposed to A oryzae spores continuously, the patient was the only family member with ABPA due to A fumigatus and possibly due to A oryzae.(ABSTRACT TRUNCATED AT 250 WORDS)