Cystic fibrosis complicated by allergic bronchopulmonary aspergillosis
Paediatric patient with known cystic fibrosis presents with worsening cough. On examination there was reduced air entry in the right upper lobe.
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There is nodular dense opacification in a finger-in-glove configuration overlying the right hilum and extending into the right upper lobe. This is likely to represent a combination of hilar lymphadenopathy and infective consolidation/bronchial plugging. In addition there is perihilar consolidation on the left.
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Atopic patients are predisposed to allergic broncho-pulmonary aspergillosis (ABPA) through defective immuno-regulation. Both asthma and cystic fibrosis are strongly associated with atopy. Presenting symptoms raising the possibility of ABPA in these patient groups include worsening respiratory symptoms, low-grade fever, weight loss and malaise.
-  http://emedicine.medscape.com/article/353200-overview#showall
-  http://emedicine.medscape.com/article/296052-workup