Allergic Bronchopulmonary Aspergillosis (ABPA)

WHAT IS IT?

Hypersensitivity response to Aspergillus fumigatus in the airways

 • Primarily affects individuals with underlying asthma or cystic fibrosis

 • Aspergillus in susceptible hosts results in an inflammatory response leading to airway increased mucus production and can result in

bronchiectasis

WHAT ARE THE CLINICAL SYMPTOMS?

 • Wheezing

 • Increased cough or production - Can see thick dark mucus plugs

 • Low grade fever, malaise, weight loss

WHAT CAN YOU SEE ON CT?

 • Mucoid impaction of the airways

 • Fleeting parenchymal opacities

 • Lobar collapse

 • Central bronchiectasis

WHAT DO YOU LOOK FOR ON LABORATORY EVALUATION?

 • Elevated Total IgE ( >1000 IU)

 • Presence of Aspergillus specific lgE

 • Immediate type-skin reaction to Aspergillus

 • Peripheral eosinophilia and Aspergillus IgG may also be present

HOW IS IT TREATED?

 • Systemic corticosteroids +/- anti-fungal therapy with an azole agent (itraconazole or voriconazole)

 • Anti-lgE therapy (Omalizumab) can be considered as as steroid sparing agent



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