Presentation
Patient with a history of seasonal atopy, asthma in childhood, and kidney transplant. Smoking: 10 pack-year history. The patient was consulted for episodes of dry cough, dyspnea, and rhonchi. No fever.
Patient Data
Tubular bronchiectasis can be seen in the right upper lobe and posterior segment of the right lower lobe, some of which present spontaneously dense endoluminal material (90 HU), which extends from the hilum to the periphery (finger in glove sign). Associated with this, centrilobular nodules can be seen, some of them convergent, with a predominance of the posterior segment of the lower right lobe, conforming to a tree-in-bud pattern. Heterogeneity of densities of the endoluminal material, corresponding to different evolutionary stages of mucous plugs, can be noticed in the mediastinal window.
No hilar or mediastinal lymphadenopathy. No pleural or pericardial effusion.
Case Discussion
Allergic bronchopulmonary aspergillosis (ABPA) is a rare condition caused by inhalation of spores of the Aspergillus fungus (mainly fumigatus species), which triggers a hypersensitivity reaction to endobronchial growth. It affects asthmatic and atopic patients more frequently. and cystic fibrosis patients less frequently. Our patient is also immunosuppressed due to his kidney transplant.
The diagnosis is made with clinical, laboratory and imaging criteria. Our patient met the clinical and imaging criteria. Laboratory results yield: Eosinophils 13%. VSG 18 mm. Total IgE 1600. IgE AF 53 ku / L (very high value). AF: Aspergillus Fumigatus.
Fulfilling the criteria for the diagnosis of ABPA, it was decided to perform fiberoptic bronchoscopy with bronchoalveolar lavage results pending. Although the isolation of the fungus in respiratory secretions supports the diagnosis, it is not an exclusive criterion for it.