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[A case of probable allergic bronchopulmonary aspergillosis due to Aspergillus niger]
1Department of Internal Medicine, Kumamoto National Hospital, Japan.
Abstract:
We report a case of probable allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus niger. An 80-year-old woman was admitted to our hospital because of wheezing, expectoration of a mucous plug and atelectasis of the right lower lobe as seen on a chest X-ray film. The patient had eosinophilia and immediate wheal-and-flare skin reactivity to A. fumigatus. Serum precipitating antibodies against A. niger and elevated serum IgE, however, were absent. Mucus impaction and bronchiectasis were revealed by both bronchoscopy and CT scanning. The mucous plug contained A. niger, numerous eosinophils and Charcot-Leyden crystals. Corticosteroid therapy ameliorated the symptoms and abnormal laboratory findings. Therefore, this was a rare, informative case of probable ABPA due to A. niger associated with a normal level of serum IgE and negative precipitation antibodies against A. niger antigen.
Insights
This study details a rare case of probable allergic bronchopulmonary aspergillosis (ABPA) caused by Aspergillus niger, even with normal IgE levels. This finding expands understanding of ABPA diagnostics.
Area of Science:
- Pulmonology
- Mycology
- Immunology
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is typically associated with Aspergillus fumigatus.
- Diagnosis often relies on elevated IgE levels and specific antibodies.
- Aspergillus niger is an uncommon cause of ABPA.
Observation:
- An 80-year-old woman presented with wheezing, mucous plugs, and right lower lobe atelectasis.
- She exhibited eosinophilia and skin reactivity to A. fumigatus.
- Imaging revealed mucus impaction and bronchiectasis.
Findings:
- The mucous plug contained Aspergillus niger, eosinophils, and Charcot-Leyden crystals.
- Crucially, serum IgE levels were normal, and precipitating antibodies against A. niger were absent.
- Corticosteroid treatment improved symptoms and laboratory markers.
Implications:
- This case highlights a probable ABPA due to Aspergillus niger with atypical serological findings.
- It suggests that ABPA can occur in the absence of elevated IgE and specific precipitating antibodies.
- This case broadens the diagnostic criteria and understanding of ABPA pathogenesis.