title: Eosinophilic Granulomatosis with Polyangiitis preceding allergic bronchopulmonary aspergillosis.
abstract: A 61-year-old Chinese man with long-standing, stable Eosinophilic Granulomatosis with Polyangiitis (EGPA) and asthma, presented with acute hypoxemia and declining obstructive pulmonary function. Elevated serum IgE levels, positive Aspergillus fumigatus specific IgE and CT findings of central bronchiectasis with small airway mucoid impaction confirmed new development of Allergic Bronchopulmonary Aspergillosis (ABPA). The maintenance therapy for EGPA, azathioprine, was discontinued. Prednisolone 0.5 mg/kg/day and Itraconazole improved his symptoms and IgE levels. To our knowledge, ABPA occurring in a patient with EGPA has not been reported. Differentiation of EGPA with asthmatic flare vs ABPA vs asthma with aspergillus hypersensitivity is discussed. Heightened Th2 immunity where eosinophils play a central role may link these conditions.
authors.affiliation: University Medicine Cluster, Internal Medicine Residency, National University Health System, Singapore.
authors.forename: W
authors.initials: W
authors.lastname: Lee
authors.affiliation: University Medicine Cluster, Division of Respiratory and Critical Care Medicine, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
authors.forename: F S W
authors.initials: FS
authors.lastname: Teo
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
authors.forename: A
authors.initials: A
authors.lastname: Santosa
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
authors.forename: G G
authors.initials: GG
authors.lastname: Teng
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D001232:Aspergillus fumigatus / Q000276:immunology; D001379:Azathioprine / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D057915:Drug Substitution; D005938:Glucocorticoids / Q000627:therapeutic use; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D007073:Immunoglobulin E; D001379:Azathioprine
keywords: Allergic Bronchopulmonary Aspergillosis; Asthma; Churg Strauss Syndrome; Obstructive lung physiology