[Allergic bronchopulmonary aspergillosis in internal medicine]

Allergic bronchopulmonary aspergillosis (ABPA) is a rare respiratory disease. Unlike other pulmonary aspergilloses resulting from an invasive infection by Aspergillus fumigatus, ABPA is a symptomatic colonization due to the allergic and inflammatory reaction. The presence of an underlying bronchial disease and an atopic background predispose to the development of ABPA. The most common clinical manifestation is a productive cough with excretion of bronchial mucus, but other presentations are possible, including poorly controlled asthma with corticosteroid dependence. Diagnosis is based on a combination of clinical, biological and imaging evidence. Internists come across this pathology as a differential diagnosis to the pathologies usually followed in internal medicine, but also as an aggravating factor in the respiratory problems of our patients. Joint management with a respirologist is necessary to avoid irreversible structural and functional sequelae. Treatments target inflammation (corticoids) and/or aspergillosis (antifungals). Biotherapies, currently being evaluated, could in the future complete the therapeutic arsenal.