title: Allergic bronchopulmonary aspergillosis with aspergilloma: an immunologically severe disease with poor outcome.
abstract: OBJECTIVE
  The association between allergic bronchopulmonary aspergillosis (ABPA) and aspergilloma has been proposed as a severe form of ABPA. However, this conclusion is based on single-patient case reports. In this study, we describe the clinical details and immunological findings of this association and compare patients of ABPA with aspergilloma and those without.
  
  
  METHODS
  This is a retrospective analysis of data of patients with ABPA managed in the Chest Clinic. We compared the clinical, radiological and immunological profile of patients with ABPA and central bronchiectasis, with and without the presence of aspergilloma on HRCT scan.
  
  
  RESULTS
  There were 98 men and 81 women with a mean (SD) age of 33.6 (12.2) years. Eight patients were diagnosed to have aspergilloma. Sputum cultures grew Aspergillus fumigatus in all these eight patients. The aspergilloma was solitary in six patients, and two each in two patients. Patients with aspergilloma had higher IgE levels (both total and A. fumigatus specific) than those without aspergilloma. Bronchiectasis was also more extensive in patients with aspergilloma. Overall, 70 % of the ABPA patients experienced relapse during the median (interquartile range) follow-up of 27 (19-39) months. The number of relapses was significantly higher in patients with aspergilloma (p = 0.0001). On a multivariate linear regression analysis, high-attenuation mucus and aspergilloma were independent predictors of relapse frequency.
  
  
  CONCLUSIONS
  The concurrent presentation of ABPA and aspergilloma is associated with an immunologically severe disease and risk of recurrent relapses.
authors.affiliation: Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. riteshpgi@gmail.com
authors.forename: Ritesh
authors.initials: R
authors.lastname: Agarwal
authors.forename: Ashutosh N
authors.initials: AN
authors.lastname: Aggarwal
authors.forename: Mandeep
authors.initials: M
authors.lastname: Garg
authors.forename: Biman
authors.initials: B
authors.lastname: Saikia
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Gupta
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
mesh_terms: D000328:Adult; D000908:Antibodies, Fungal / Q000097:blood; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000473:pathology*; D001232:Aspergillus fumigatus / Q000472:pathogenicity*; D001987:Bronchiectasis / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000908:Antibodies, Fungal; D007073:Immunoglobulin E