title: A case of allergic bronchopulmonary aspergillosis leading to pneumonia with unusual organisms.
abstract: We describe the case of a 50-year-old male with a history of asthma and seizure disorder who presented with a 5-month history of dyspnea. The patient had been treated with multiple courses of antibiotics for presumed community-acquired pneumonia before being determined to have allergic bronchopulmonary aspergillosis (ABPA) by serologic and radiographic criteria. Inflammation resulting from this disease had potentiated a postobstructive pneumonia caused by Nocardia asteroides and Stenotrophomonas maltophilia. Therapy with corticosteroids, trimethoprim sulfa, and voriconazole failed to prevent subsequent destruction of the right upper lobe and the patient required surgical intervention. The discussion emphasizes the diagnostic criteria for ABPA including historic, serologic, and radiographic findings; staging, and treatment. Other possible diagnoses, such as invasive pulmonary aspergillosis, chronic necrotizing aspergillosis, and hyper-IgE syndrome are also briefly reviewed.
authors.affiliation: Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA. brown.mccallum@med.va.gov
authors.forename: Brown James
authors.initials: BJ
authors.lastname: McCallum
authors.forename: David
authors.initials: D
authors.lastname: Amrol
authors.forename: Joseph
authors.initials: J
authors.lastname: Horvath
authors.forename: Nadeem
authors.initials: N
authors.lastname: Inayat
authors.forename: Rohit
authors.initials: R
authors.lastname: Talwani
mesh_terms: D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000150:complications; D009616:Nocardia asteroides / Q000302:isolation & purification; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000382:microbiology*; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification