A case of Allergic bronchopulmonary aspergillosis, ABPA mimicking lung cancer

Aspergillus infections of the lung have varied presentations. including Allergic bronchopulmonary aspergillosis (ABPA) in which there is a hypersensitivity reaction to Aspergillus antigens. It is commonly seen in asthmatics and patients with cystic fibrosis.Dr.Arun Kannan at Sri Ramachandra Medical College and Research Institute, Porur, Chennai, and associates have reported a case of ABPA in a 55-year-old male initially evaluated for left lung cancer who had never been diagnosed with asthma. The case has appeared in Indian Journal of Allergy, Asthma, and Immunology.

A 55-year-old male, non-smoker, with no previous comorbidities, was referred to our institution as a suspected case of lung cancer. He had been having a cough with mucoid expectoration for about a month prior to admission and had taken oral antibiotics and antihistaminics for the same. He also complained of breathlessness and weight loss of 4 kg. He had no hemoptysis or fever. He had had a chest X-ray taken at an outside hospital which had shown a left mid-zone nonhomogeneous opacity and hence had been referred to as lung cancer. At admission, his general condition was good. Auscultation of his chest revealed few crepitations in the left mammary area.

Fig 1

Courtesy Indian Journal of Allergy, Asthma, and Immunology

Blood investigations revealed a total white blood cell count of 10,900 with eosinophils of 18.8% and absolute eosinophil count of 1626 and IgE level being 1480 IU/ml. Chest X-ray showed a left mid-zone nonhomogeneous opacity.

Computed tomography (CT) thorax was done which revealed symmetrical focal central bronchiectasis with the surrounding patch of consolidation involving part of upper and middle lobes [Figure 2]. Based on this, a suspicion of ABPA was raised. Microbiological analysis of the sputum revealed Aspergillus fumigatus colonies. The serological test was positive for Aspergillus antibodies. Aspergellin skin test was positive. With these, we came to a diagnosis of ABPA and ruled out lung cancer (six out of eight in Rosenberg-Patterson criteria)

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Fig 2

Courtesy Indian Journal of Allergy, Asthma, and Immunology

The patient was treated with oral prednisolone 0.5 mg/kg/day which was gradually tapered and with itraconazole 400 mg twice daily for 3 days followed by 200 mg twice a day for 16 weeks. Clearance of the radiological opacity and reduction in IgE levels were observed during follow-up.

For more details click on the link : DOI: 10.4103/0972-6691.195264