A 40-year-old man presented with repeated episodes of bronchospasm and hemoptysis. Chest X-ray revealed perihilar bronchiectasis. The most likely diagnosis is:
Correct Answer: Bronchopulmonary aspergillosis
Description: Ans: D (Bronchopulmonary aspergillosis) Ref: Harrisons Textbook of Internal Medicine, 17th ed 197 chapterExplanation:Perihilar or central bronchiectasis is characteristic of ABPAAllergic Bronchopulmonary Aspergillosis(ABPA)Aspergillus may cause a broad spectrum of disease in the human host, ranging from hypersensitivity reactions to direct angioinvasion.Aspergillus primarily affects the lungs, causing 4 main syndromes, including:Allergic Bronchopulmonary Aspergillosis (ABPA),Chronic Necrotizing Aspergillus Pneumonia or Chronic Necrotizing Pulmonary AspergillosisAspergillomaInvasive aspergillosisAllergic bronchopulmonary aspergillosis (ABPA) is caused by a hypersensitivity reaction to the fungus and most commonly occurs in those with asthma and cystic fibrosis .In almost all cases, ABPA represents a hypersensitivity reaction to A. fumigatus.ABPA occurs in ~1% of patients with asthma and in up to 15% of adults with cystic fibrosis.Episodes of bronchial obstruction with mucous plugs leading to coughing fits, "pneumonia," consolidation, and breathlessness are typical.Many patients report coughing up thick sputum casts, usually brown or clear.Eosinophilia commonly develops before systemic glucocorticoids are given.The cardinal diagnostic tests include:An elevated serum level of total IgE (usually >1000 IU/mL),A positive skin-prick test to A. fumigatus extract, orDetection of Aspergillus-specific IgE and IgG (precipitating) antibodies.Central bronchiectasis is characteristic, but patients may present before it becomes apparent.Diagnostic Criteria For ABPA (Patterson Criteria)AsthmaImmediate cutaneous reaction to Aspergillus fumigatusTotal serum Ig E > 1000 ng / mlElevated serum specific Aspergillus IgE. IgGSerum precipitins to Aspergillus antigenPeripheral blood eosinophiliaTransient or fixed pulmonary infiltratesProximal bronchiectasisTreatment: Itraconazole is drug of choice along with glucocorticoids and treatment of asthma. Voriconazole may also be given.
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