ABPA sans asthma: an entity to remember.

Area of Science:

• Pulmonology
• Infectious Diseases
• Allergy Immunology

Background:

• Allergic bronchopulmonary aspergillosis (ABPA) is an immune-mediated lung disease often associated with asthma.
• Diagnosis typically relies on clinical criteria including asthma, eosinophilia, and positive Aspergillus-specific IgE.
• Rare presentations of ABPA, particularly without a history of asthma, pose diagnostic challenges.

Observation:

• A young male patient presented with chronic cough and hemoptysis.
• Initial investigations revealed peripheral eosinophilia and elevated total IgE.
• High-resolution CT scan showed bilateral bronchiectasis and mucus plugging.

Findings:

• Despite the absence of asthma symptoms and normal pulmonary function tests, imaging and serological findings were suggestive of ABPA.
• Skin prick tests and specific IgE assays for Aspergillus fumigatus were positive.
• Bronchoalveolar lavage confirmed Aspergillus fumigatus infection.

Implications:

• This case underscores that allergic bronchopulmonary aspergillosis can occur in individuals without a prior asthma diagnosis.
• It emphasizes the importance of considering ABPA in the differential diagnosis of chronic respiratory symptoms with eosinophilia, even in non-asthmatic patients.
• Early diagnosis and appropriate antifungal therapy are crucial for managing ABPA and preventing long-term lung damage.