Allergic bronchopulmonary aspergillosis in a patient  with chronic obstructive pulmonary disease.
Allergic bronchopulmonary aspergillosis (ABPA) is a debilitating lung disease which occurs as a result of interplay between a variety of  host and environmental factors. It occurs in certain susceptible individuals who develop hypersensensitivity to the colonised Aspergillus  species. ABPA is a complicating factor in 2% of patients with asthma and is also seen in patients with cystic fibrosis. Asthma and chronic  obstructive pulmonary disease (COPD) are known to share key elements of pathogenesis. It is well known that ABPA can occur in patients  with asthma, but it has recently been reported in patients with COPD as well. We report a 55-year-old male ex-smoker who presented  with complaints of exertional breathlessness and productive cough for five years and an episode of haemoptysis four days prior to  presentation. Spirometery showed airflow obstruction which was not reversible with bronchodilators. Chest CT scan revealed paraseptal  emphysema along with central bronchiectasis (CB) in the right upper lobe and bilateral lower lobes. A type I skin hypersensitivity reaction  to Aspergillus species was elicited. He fulfilled the serological criteria for ABPA and was diagnosed as having concomitant COPD and  ABPA-CB. The patient was initiated on therapy for COPD along with oral corticosteroids, on which he had remarkable symptomatic  improvement.
Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
Elias
E
Mir
Ashok
A
Shah
D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications* / Q000000981:diagnostic imaging; D001987:Bronchiectasis / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed