Allergic Bronchopulmonary Aspergillosis (ABPA) WHAT IS IT? Hypersensitivity response to Aspergillus fumigatus in the airways • Primarily affects individuals with underlying asthma or cystic fibrosis • Aspergillus in susceptible hosts results in an inflammatory response leading to airway increased mucus production and can result in bronchiectasis WHAT ARE THE CLINICAL SYMPTOMS? • Wheezing • Increased cough or production - Can see thick dark mucus plugs • Low grade fever, malaise, weight loss WHAT CAN YOU SEE ON CT? • Mucoid impaction of the airways • Fleeting parenchymal opacities • Lobar collapse • Central bronchiectasis WHAT DO YOU LOOK FOR ON LABORATORY EVALUATION? • Elevated Total IgE ( >1000 IU) • Presence of Aspergillus specific lgE • Immediate type-skin reaction to Aspergillus • Peripheral eosinophilia and Aspergillus IgG may also be present HOW IS IT TREATED? • Systemic corticosteroids +/- anti-fungal therapy with an azole agent (itraconazole or voriconazole) • Anti-lgE therapy (Omalizumab) can be considered as as steroid sparing agent Pulm PEEPs @PulmPEEPs #Allergic #Bronchopulmonary #Aspergillosis #ABPA #pulmonary #diagnosis #management
