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Published on: March 22, 2012
Middle lobe syndrome: a rare presentation of allergic bronchopulmonary aspergillosis
A Shah1, S Behera1, C Panjabi2
1Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India.
Abstract:
Allergic bronchopulmonary aspergillosis (ABPA) is a disease predominantly seen in susceptible asthmatic subjects, due to a hypersensitivity phenomenon caused by colonisation of the airways by Aspergillus species. Although collapse, both lobar and segmental due to mucoid impaction, is not uncommon in ABPA, a middle lobe syndrome (MLS) secondary to ABPA is rather an uncommon association. We report this rare and unusual clinical presentation in a 36-year-old male, who presented for evaluation of a "non resolving pneumonia". Imaging suggested the presence of a MLS and central bronchiectasis. Further investigations revealed that the patient met 6/8 of the essential diagnostic criteria for ABPA. Appropriate therapy with oral corticosteroids resulted in remarkable symptomatic improvement.
Insights
Allergic bronchopulmonary aspergillosis (ABPA) can uncommonly cause middle lobe syndrome (MLS). This case highlights a rare presentation of ABPA mimicking non-resolving pneumonia, successfully treated with corticosteroids.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Infectious Diseases
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease caused by hypersensitivity to Aspergillus species in asthmatic individuals.
- Mucoid impaction leading to lobar or segmental collapse is a known complication of ABPA.
- Middle lobe syndrome (MLS) as a manifestation of ABPA is considered rare.
Observation:
- A 36-year-old male presented with symptoms suggestive of a non-resolving pneumonia.
- Imaging revealed findings consistent with MLS and central bronchiectasis.
- The patient met diagnostic criteria for ABPA.
Findings:
- The patient's condition was diagnosed as MLS secondary to ABPA.
- Treatment with oral corticosteroids led to significant symptom improvement.
Implications:
- This case underscores the importance of considering ABPA in the differential diagnosis of middle lobe syndrome, even in atypical presentations.
- Early diagnosis and treatment of ABPA-associated MLS can lead to favorable outcomes.
- Further research may elucidate the mechanisms behind this uncommon association.
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