Hilar adenopathy in allergic bronchopulmonary aspergillosis.
BACKGROUND
A 20-year-old male student developed allergic bronchopulmonary aspergillosis (ABPA). Computed tomography (CT) of the thorax done to detect central bronchiectasis (CB) for confirmation of diagnosis revealed, in addition, right hilar lymphadenopathy. Hilar adenopathy is thought to be rare in ABPA and has been documented only once before. Because of the finding of hilar adenopathy, the earlier reported patient had to undergo an invasive surgical procedure.


OBJECTIVE
To report a case of true hilar adenopathy in ABPA.


METHODS
This is a single case report. Contrast enhanced CT of the thorax was done. Serum precipitating antibodies against Aspergillus fumigatus were tested using gel diffusion technique, and intradermal testing with antigens of Aspergillus species was performed. Specific IgG antibodies against A. fumigatus and total IgE levels were measured by ELISA.


RESULTS
A review of serial chest radiographs over a period of 3 years demonstrated transient pulmonary infiltrates and right hilar prominence. Computed tomography of the thorax revealed right hilar lymphadenopathy along with bilateral central bronchiectasis and patchy infiltrates. Strong bands of precipitins were detected against A. fumigatus. Intradermal testing with antigens of Aspergillus species elicited strong type I (immediate) and type III (Arthus-type) hypersensitivity reactions to A. fumigatus and A. niger. Specific IgG antibodies against A. fumigatus was positive and total IgE level was significantly elevated. Peripheral blood eosinophilia was also detected.


CONCLUSIONS
Although extremely rare, ABPA should be considered in the differential diagnosis of hilar adenopathy.
Shah
A
A
Department of Clinical Research, Vallabhbhai Patel Chest Institute, University of Delhi, India.
Agarwal
A K
AK
Chugh
I M
IM
D000328:Adult; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications* / Q000000981:diagnostic imaging; D001987:Bronchiectasis / Q000150:complications; D003287:Contrast Media; D006801:Humans; D008206:Lymphatic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed
D003287:Contrast Media