title: Uncontrolled asthma and recurring pulmonary opacities: just asthma?
abstract: In asthma, when comorbidities and common causes of poor control have been considered and treated, the clinician may speculate, 'Is it all asthma?'. In patients with uncontrolled atopic asthma with recurring episodes of symptoms mimicking pneumonia, the suspicion of allergic bronchopulmonary aspergillosis (ABPA) should remain high. ABPA is caused by a complex immunological hypersensitivity reaction to colonisation with Aspergillus fumigatus in the bronchial tree, and is characterised by the presence of atopic asthma, blood eosinophilia, migrating pulmonary opacities and potential bronchiectasis. This case report describes a delay in diagnosing ABPA which was imitating pneumonia. The clinician should pay increased attention to ABPA and test for this in patients with uncontrolled asthma with an ongoing requirement for oral corticosteroids and/or antibiotics and with pulmonary opacities on chest imaging.
authors.affiliation: Department of Medicine, Odense University Hospital-Svendborg Hospital, Svendborg, Denmark.
authors.forename: Jesper Rømhild
authors.initials: JR
authors.lastname: Davidsen
authors.affiliation: Division of Respiratory Medicine, Littlebelt Hospital, Fredericia, Denmark.
authors.forename: Poul Henning
authors.initials: PH
authors.lastname: Madsen
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Christian B
authors.initials: CB
authors.lastname: Laursen
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D001232:Aspergillus fumigatus / Q000276:immunology; D001249:Asthma / Q000175:diagnosis*; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D017964:Itraconazole / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis*; D011239:Prednisolone / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D005938:Glucocorticoids; D017964:Itraconazole; D007073:Immunoglobulin E; D011239:Prednisolone