Presentation
Ex-smoker with severe persistent asthma. Presented with five-day history of pain in the right hemithorax that worsens with inspiration. Also, has high fever of up to 38.2º and dry cough.
Patient Data
Diffuse airway disease with varicose-type bronchiectasis involvement that predominates in the upper lobes, internal segment of the middle lobe, apical segments of the left lower lobe. There is some respect of the lingula and the right lower lobe.
Opacification of bronchiectasis of the apical and lateral segment of the left lower lobe and partially of those located in the apical segment of the right lower lobe by increased density secretions in a ‘finger in glove pattern’.
Extensive centrilobular micronodularity and 'tree in bud' pattern .
Ground glass opacities are also observed in the internal and anterior aspect of the right base of keeping with acute small airway bronchiolitic process. No abscess areas or cavitated consolidation.
No pericardial or pleural effusion. No lymphadenopathy.
Case Discussion
Allergic bronchopulmonary aspergillosis (ABPA) is a fungal infection of the lung due to a hypersensitivity reaction to antigens of Aspergillus fumigatus after colonization into the airways. Predominantly it affects uncontrolled asthmatics, cystic fibrosis patients, and immunocompromised patients. The diagnosis centers around classic clinical manifestations, radiographic findings, and immunological findings.
In this case, the clinical history consisting in a long standing severe asthma with difficult therapeutic control, the laboratory test results (elevated Immunoglobulin E: 6968.0 UI/mL, peripheral eosinophilia: 0.61 x 10^3/µL (0.00 - 0.50) ) as well as the characteristic radiological findings: central bronchiectasis predominantly in the upper lobes with mucoid impaction resulting in bronchocele formation (giving the characteristic 'finger in glove ' sign) associated with recurrent episodes of pulmonary superinfections support the diagnosis of ABPA.
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