Allergic bronchopulmonary aspergillosis as presenting sign of cystic fibrosis in an elderly man.
BACKGROUND
Although cystic fibrosis is the most common genetic disorder of children, its heterogeneous spectrum of severity lends itself to underdiagnosis in the older adult patient population where the index of suspicion is not high.


METHODS
We report a 60-year-old Hispanic man with asthma who presented with progressive dyspnea and wheezing unresponsive to inhaled corticosteroid treatment. Additionally, he had clinical findings and a past history suggestive of cystic fibrosis. Skin testing, radiography and laboratory studies were completed to evaluate for allergic bronchopulmonary aspergillosis (ABPA) and cystic fibrosis.


RESULTS
Test results revealed peripheral eosinophilia and hyper IgE. Skin testing to Aspergillus fumigatus (Af) was positive. IgG, IgM, and Af specific antibodies were present. High resolution CT scan showed central bronchiectasis. Sweat tests were positive on two separate occasions and gene analysis showed our patient to have a positive gene mutation at D127ON/D127ON.


CONCLUSIONS
Cystic fibrosis should be suspected in the older adult patient with a compatible clinical presentation.
Vilar
M E
ME
Department of Allergy and Immunology, Long Island College Hospital, Brooklyn, New York, USA.
Najib
N M
NM
Chowdhry
I
I
Bassett
C W
CW
Silverman
B A
BA
Giusti
R J
RJ
Rosa
U W
UW
Schneider
A T
AT
D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000175:diagnosis*; D001249:Asthma / Q000150:complications; D003550:Cystic Fibrosis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005192:Family Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D013183:Sputum / Q000382:microbiology