Initial imaging findings are suggestive of allergic bronchopulmonary aspergillosis (ABPA).

The other investigations are as follows:-

• mild increase in total leukocyte count with eosinophil count is ~6.6%

• total IgE level is ~1000 KIU/L (Ref. range: <150 KIU/L)

• allergy marker-aspergillus fumigatus ~9.58 kUA/l (Ref. range: 0.1)

• aspergillus antibody (IgG) ~5.94 (Ref. range <0.80)

The overall findings confirm the diagnosis of allergic bronchopulmonary aspergillosis (ABPA).

The patient was treated with antifungal agent and steroid. After six months of treatment, there is significant improvement of patient symptoms and complete resolution of high attenuation mucus plug, secretion/mucus and tree in bud nodules.

Co-author: Dr. Vijay Kumar, Pulmonologist.