[Allergic bronchopulmonary aspergillosis successfully treated with itraconazole]

A 67-year-old man was admitted to our hospital because of coughing, a low-grade fever, and abnormal shadows on a chest X-ray film. He had had asthma as a child, but had no asthmatic symptoms on admission. A CT scan showed collapse of the right middle lobe and mucoid impactions in the lingula. Bronchoscopy revealed thick mucus obstructing the right middle-lobe bronchus and the left upper-lobe bronchus. The eosinophil count and the IgE level were abnormally high. Aspergillus fumigatus was detected in his sputum. Tests for immediate skin reaction and precipitating antibody to aspergillus antigen were positive. After treatment with itraconazole he became asymptomatic. Radiographic abnormalities had resolved by 1 month after the start of treatment; a high resolution CT scan obtained after clinical improvement revealed central bronchiectasis. In this patient with allergic bronchopulmonary aspergillosis, a course of itraconazole alone was followed by satisfactory improvement.