Allergic Bronchopulmonary Aspergillosis Masquerading as Recurrent Bacterial Pneumonia

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity-driven reaction to antigens in Aspergillus. The symptoms are indistinguishable from other more common disorders such as bronchopulmonary pneumonia and pulmonary tuberculosis (TB). Ambiguity in clinical presentation and an overall low prevalence contribute to frequent misdiagnosis of ABPA. High-risk patients for sensitization include a history of atopy, asthma, immunocompromised, or underlying pulmonary condition. It is common for misdiagnosed ABPA patients to receive several courses of anti-TB therapy even with smear-negative testing. The discussed case shows that the patient was initially treated for bacterial pneumonia with mild improvement despite a high total serum IgE and positive specific immunoglobulin G (IgG) to Aspergillus. It was not until a bronchoscopy showing mucous plugging and culture from bronchoalveolar lavage (BAL) that serologic ABPA (ABPA-S) was confirmed. Close attention to eosinophilia, specific and total immunoglobulin E (IgE), and skin prick testing standardization are proposed to improve the accurate and early diagnosis of ABPA.