Clinical Analysis of Four Cases of Allergic Bronchopulmonary Aspergillosis and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

PengJuan ¹ ,  HanFengfeng ¹ , YangTianyun ¹ , JiaQin ¹ , SunJinyuan ¹ , GuanWenbin ² , LiHuimin ³ , GuoXuejun ¹

1. Department of Respiratory Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China;
2. ;
3. ;

Corresponding?author：

HanFengfeng, Email: fengfh86@sina.com

Keywords：

Allergic bronchopulmonary aspergillosis; Diagnosis; Treatment; Bronchial asthma

DOI：

10.7507/1671-6205.2015112

Video：

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Objective To investigate the clinical manifestations, diagnosis and treatments of allergic bronchopulmonary aspergillosis (ABPA). Methods The clinical data of four cases of ABPA diagnosed in our department between 2009 and 2014 were analyzed. The related literature was also reviewed. Results ABPA tends to occur in people with chronic lung diseases, such as asthma and cystic fibrosis. The main clinical manifestations are wheezing, fever, cough, and sputum production. Laboratory examinations include immediate Aspergillus skin test reactivity, elevated total serum IgE and Aspergillus specific IgE and IgG antibodies, and peripheral blood eosinophilia. Radiological findings include recurrent chest roentgenographic infiltrates and central bronchiectasis. Treatments involve corticosteroids and antifungal therapy with itraconazole. Conclusions ABPA is easy to misdiagnosis clinically. It should be considered in patients with poor controlled asthma and asthmatic patients with acute pulmonary infiltrates. Early diagnosis and proper treatment can minimize lung injury from ABPA and improve outcomes.

Citation： PengJuan, HanFengfeng, YangTianyun, JiaQin, SunJinyuan, GuanWenbin, LiHuimin, GuoXuejun. Clinical Analysis of Four Cases of Allergic Bronchopulmonary Aspergillosis and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(5): 456-461. doi: 10.7507/1671-6205.2015112 Copy

1.	Hinson KF, Moon AJ, Plummer NS.Broncho-pulmonary aspergillosis:a review and a report of eight new cases.Thorax, 1952, 7:317-333.
2.	Chauhan B, Santiago L, Kirsehmann DA, et al.The association of HLA-DR alleles and T cell activation with allergic bronchopulmonary aspergillosis.J Immunol, 1997, 159:4072-4076.
3.	Lazarus AA, Thilagar B, McKay SA.Allergic bronchopulmonary aspergillosis.Dis Mon, 2008, 54:547-564.
4.	Patterson R, Greenberger PA, Radin RC, et al.Allergic bronchopulmonary aspergillosis:staging as an aid to management.Ann Intern Med, 1982, 96:286-291.
5.	Patterson R, Greenberger PA, Halwig JM, et al.Allergic bronchopulmonary aspergillosis:natural history and classification of early disease by serologic and roentgenographic studies.Arch Intern Med, 1986, 146:916-918.
6.	Kumar R.Mild, moderate, and severe forms of allergic bronchopulmonary aspergillosis:a clinical and serologic evaluation.Chest, 2003, 124:890-892.
7.	Agarwal R.Allergic bronchopulmonary aspergillosis:lessons for the busy radiologist.World J Radiol, 2011, 3:178-181.
8.	Walsh TJ, Anaissie EJ, Denning DW, et al.Treatment of aspergillosis:Clinical Practice Guidelines of the Infectious Diseases Society of America.Clin Infect Dis, 2008, 46:327-360.
9.	Wark PA, Gibson PG.Allergic bronehopulmonary aspergillosis:new concepts of pathogenesis and treatment.Respirology, 2001, 6:1-7.
10.	Greenberger PA.Allergic bronchopulmonary aspergillosis.J Allergy Clin Immunol, 2002, 110:685-692.
11.	Ricketti AJ, Greenberger PA, Patterson R.Serum IgE as an important aid in management of allergic bronchopulmonary aspergillosis.J Allergy Clin Immunol, 1984, 74:68-71.
12.	Malde B, Greenberger PA.Allergic bronchopulmonary aspergillosis.Allergy Asthma Proc, 2004, 25:S38-S39.
13.	Stevens DA, Schwartz HJ, Lee JY, et al.A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis.N Engl J Med, 2000, 342:756-762.
14.	Wark PA, Hensley MJ, Saltos N, et al.Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis:a randomized controlled trial.J Allergy Clin Immunol, 2003, 111:952-957.
15.	Wark P.Pathogenesis of allergic bronchopulmonary aspergillosis and an evidence-based review of azoles in treatment.Respir Med, 2004, 98:915-923.
16.	Wark PA, Gibson PG, Wilson AJ.Azoles for allergic bronchopulmonary aspergillosis associated with asthma.Cochrane Database Syst Rev, 2003, 3:CD 001108.
17.	van der Ent CK, Hoekstra H, Rijkers GT.Successful treatment of allergic bronchopulmonary aspergillosis with recombinant anti-IgE antibody.Thorax, 2007, 62:276-277.
18.	陸海雯, 衛平, 徐金富.變應性支氣管肺曲霉病的診斷標準變遷及影像學分類進展.中國呼吸與危重監護雜志, 2014, 13:102-104.

1. Hinson KF, Moon AJ, Plummer NS.Broncho-pulmonary aspergillosis:a review and a report of eight new cases.Thorax, 1952, 7:317-333.
2. Chauhan B, Santiago L, Kirsehmann DA, et al.The association of HLA-DR alleles and T cell activation with allergic bronchopulmonary aspergillosis.J Immunol, 1997, 159:4072-4076.
3. Lazarus AA, Thilagar B, McKay SA.Allergic bronchopulmonary aspergillosis.Dis Mon, 2008, 54:547-564.
4. Patterson R, Greenberger PA, Radin RC, et al.Allergic bronchopulmonary aspergillosis:staging as an aid to management.Ann Intern Med, 1982, 96:286-291.
5. Patterson R, Greenberger PA, Halwig JM, et al.Allergic bronchopulmonary aspergillosis:natural history and classification of early disease by serologic and roentgenographic studies.Arch Intern Med, 1986, 146:916-918.
6. Kumar R.Mild, moderate, and severe forms of allergic bronchopulmonary aspergillosis:a clinical and serologic evaluation.Chest, 2003, 124:890-892.
7. Agarwal R.Allergic bronchopulmonary aspergillosis:lessons for the busy radiologist.World J Radiol, 2011, 3:178-181.
8. Walsh TJ, Anaissie EJ, Denning DW, et al.Treatment of aspergillosis:Clinical Practice Guidelines of the Infectious Diseases Society of America.Clin Infect Dis, 2008, 46:327-360.
9. Wark PA, Gibson PG.Allergic bronehopulmonary aspergillosis:new concepts of pathogenesis and treatment.Respirology, 2001, 6:1-7.
10. Greenberger PA.Allergic bronchopulmonary aspergillosis.J Allergy Clin Immunol, 2002, 110:685-692.
11. Ricketti AJ, Greenberger PA, Patterson R.Serum IgE as an important aid in management of allergic bronchopulmonary aspergillosis.J Allergy Clin Immunol, 1984, 74:68-71.
12. Malde B, Greenberger PA.Allergic bronchopulmonary aspergillosis.Allergy Asthma Proc, 2004, 25:S38-S39.
13. Stevens DA, Schwartz HJ, Lee JY, et al.A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis.N Engl J Med, 2000, 342:756-762.
14. Wark PA, Hensley MJ, Saltos N, et al.Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis:a randomized controlled trial.J Allergy Clin Immunol, 2003, 111:952-957.
15. Wark P.Pathogenesis of allergic bronchopulmonary aspergillosis and an evidence-based review of azoles in treatment.Respir Med, 2004, 98:915-923.
16. Wark PA, Gibson PG, Wilson AJ.Azoles for allergic bronchopulmonary aspergillosis associated with asthma.Cochrane Database Syst Rev, 2003, 3:CD 001108.
17. van der Ent CK, Hoekstra H, Rijkers GT.Successful treatment of allergic bronchopulmonary aspergillosis with recombinant anti-IgE antibody.Thorax, 2007, 62:276-277.
18. 陸海雯, 衛平, 徐金富.變應性支氣管肺曲霉病的診斷標準變遷及影像學分類進展.中國呼吸與危重監護雜志, 2014, 13:102-104.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical Analysis of Four Cases of Allergic Bronchopulmonary Aspergillosis and Literature Review

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