[Allergic bronchopulmonary aspergillosis. A report of a case and literature review].
Allergic bronchopulmonary aspergillosis is a world rare disease with a prevalence between 1 and 2%. It presents in moderate-severe asthma and cistic fibrosis patients. The diagnosis is made in the basis of Rossenberg and Greenberg criteria that can be essential or non essential. We present the case of a 3-year-old boy with allergic bronchopulmonary aspergillosis without bronchiectasies and with a good response to corticosteroids. His mother complained of two years of nasal obstruction, purulent rinorrea, nasal pruritus, sneezing, chronic cough and recurrent wheezing, twice to thrice a month. He also occasionally had vomits and diarrhea in relation with strawberries, banana, cow's milk and chocolate. We made the diagnosis of asthma, allergic rhinitis, sinusitis, and probably food allergy. We treated him with step approach of ICS according to GINA 2006, albuterol PRN, and elimination diet, with bad response. Laboratory exams: Blood white cells with eosinophilia (6%), total serum IgE: 1684 ng/L, aspergillus skin prick test: 4mm, serum IgG-Aspergillus fumigatus: 2.3 mcg/mL, serum IgE-Aspergillus fumigatus: negative, chest roentgenographic parahiliar and apical infiltrates, and chest computed tomography without bronchiectasies. We added prednisone to the treatment for four months, and we observed a very good response; he is now in treatment as mild persistent asthma with ICS low doses. ABPA must be suspected in patients with moderate-severe persistent asthma and a skin prick test positive to Aspergillus fumigatus regardless the age. The treatment with oral corticosteroids is the mainstream of management, and most of the patients have a good response, as we observed with this patient.
Meza Brítez
Ricardo L
RL
Departamento de Alergia e Inmunología Clínica, Hospital Infantil de México Federico Gómez. Dr. Márquez 162, colonia Doctores, CP 06720, México, DF. dr_meza_py@yahoo.com
del Río Navarro
Blanca E
BE
Ochoa López
Georgina
G
Pietropaolo Cienfuegos
Dino
D
del Río Chivardi
Jaime M
JM
Rosas Vargas
Miguel A
MA
D000908:Antibodies, Fungal / Q000097:blood / Q000276:immunology; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D001232:Aspergillus fumigatus / Q000276:immunology*; D001249:Asthma / Q000150:complications; D002675:Child, Preschool; D002908:Chronic Disease; D004802:Eosinophilia / Q000209:etiology; D005512:Food Hypersensitivity / Q000150:complications; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D012852:Sinusitis / Q000150:complications; D012882:Skin Tests; D014057:Tomography, X-Ray Computed
D000908:Antibodies, Fungal; D007074:Immunoglobulin G; D011241:Prednisone