Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2023; 11(11): 2457-2463
Published online Apr 16, 2023. doi: 10.12998/wjcc.v11.i11.2457
Allergic bronchopulmonary aspergillosis with marked peripheral blood eosinophilia and pulmonary eosinophilia: A case report
Xiao-Xi Zhang, Rong Zhou, Chang Liu, Jing Yang, Zi-Han Pan, Cen-Cen Wu, Qiu-Yu Li
Xiao-Xi Zhang, Chang Liu, Department of Emergency Medicine, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
Rong Zhou, Department of Sleep Medicine, Peking University Sixth Hospital, Beijing 100191, China
Jing Yang, Department of Pathology, Peking University Third Hospital, Beijing 100191, China
Zi-Han Pan, Cen-Cen Wu, Qiu-Yu Li, Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
Author contributions: Zhang XX was responsible for collecting the original data and writing the manuscript; Liu C was responsible for collecting the imaging data; Zhou R and Wu CC were responsible for writing the discussion; Pan ZH and Rong Z were responsible for modifying the format; Yang J was responsible for collecting the pathological pictures; Li QY was responsible for comprehensively designing the case report framework and modifying the logic and language; all authors have read and approved the final manuscript; Li QY and Wu CC, as co correspondents, are responsible for this manuscript.
Supported by the National Natural Science Foundation of China, No. 81900641; the Research Funding of Peking University, No. BMU2021MX020, No. BMU2022MX008.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiu-Yu Li, MD, Chief Doctor, Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China. liqiuyu00@bjmu.edu.cn
Received: September 20, 2022
Peer-review started: September 20, 2022
First decision: November 11, 2022
Revised: December 4, 2022
Accepted: March 20, 2023
Article in press: March 20, 2023
Published online: April 16, 2023
Processing time: 198 Days and 0.6 Hours
Abstract
BACKGROUND

Allergic bronchopulmonary aspergillosis (ABPA) is an immune-related pulmonary disease caused by sensitization of airway by Aspergillus fumigatus. The disease manifests as bronchial asthma and recurring pulmonary shadows, which may be associated with bronchiectasis. The diagnosis of ABPA mainly depends on serological, immunological, and imaging findings. Pathological examination is not necessary but may be required in atypical cases to exclude pulmonary tuberculosis, tumor, and other diseases through lung biopsy.

CASE SUMMARY

An 18-year-old man presented with recurrent wheezing, cough, and peripheral blood eosinophilia. Chest computed tomography showed pulmonary infiltration. There was a significant increase in eosinophils in bronchoalveolar lavage fluid. There was no history of residing in a parasite-endemic area or any evidence of parasitic infection. Pathologic examination of bronchoalveolar lavage fluid excluded fungal and mycobacterial infections. The patient was receiving medication for comorbid diseases, but there was no temporal correlation between medication use and clinical manifestations, which excluded drug-induced etiology. Histopathological examination of lung biopsy specimen showed no signs of eosinophilic granulomatosis with polyangiitis, IgG4-related diseases, or tumors. The diagnosis of ABPA was considered based on the history of asthma and the significant increase in serum Aspergillus fumigatus-specific immunoglobulin (Ig)E. Eosinophil-related diseases were excluded through pathological biopsy, which showed typical pathological manifestations of ABPA.

CONCLUSION

The possibility of ABPA should be considered in patients with poorly controlled asthma, especially those with eosinophilia, lung infiltration shadows, or bronchiectasis. Screening for serum IgE, Aspergillus fumigatus-specific IgE and IgG, and alveolar lavage can help avoid misdiagnosis.

Keywords: Allergic bronchopulmonary aspergillosis; Asthma; Aspergillus; Case report

Core Tip: Clinically, allergic bronchopulmonary aspergillosis should be considered for patients with poorly controlled asthma, especially those with elevated eosinophils, pulmonary infiltrates, or bronchiectasis. Serum total immunoglobulin (Ig)E (IgE), Aspergillus fumigatus-specific antibody IgE and IgG detection can help confirm the diagnosis.