Allergic Bronchopulmonary Aspergillosis Misdiagnosed as Non-resolving Pneumonia: A Case Report

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction triggered by Aspergillus fumigatus colonization of the airways that primarily affects immunocompetent individuals, particularly those with asthma. ABPA can often be misdiagnosed as severe asthma or non-resolving pneumonia, leading to delays in appropriate management. Early recognition of ABPA is crucial to prevent disease progression and unnecessary antibiotic use. We report a case of a 28-year-old female with a long-standing history of poorly controlled asthma who presented with fever, productive cough, and radiographic findings initially suggestive of non-resolving pneumonia. Despite receiving multiple courses of antibiotics, her symptoms persisted. Further investigations, including elevated total serum IgE levels, Aspergillus-specific IgE, eosinophilia, and negative mycobacterial cultures, confirmed a diagnosis of ABPA. The patient was successfully treated with systemic corticosteroids (prednisone) and itraconazole, leading to significant clinical and radiological improvement over 2 months. Her IgE levels markedly decreased, supporting resolution of the hypersensitivity reaction. This case underscores the importance of recognizing ABPA in patients with recurrent asthma exacerbations and unexplained pulmonary symptoms. Given the potential for misdiagnosis as pneumonia, clinicians should maintain a high index of suspicion for ABPA, particularly in cases of non-resolving pneumonia where antibiotic therapy fails to achieve improvement.