A 42-year-old female architect reported having had a cough for ten years. The cough had begun when she was on holiday at a beach house, where she noticed a strong mold smell. Since then, she had been experiencing fits of coughing, either dry cough or cough producing dense, greenish sputum. In addition to the mold, the patient mentioned other factors, such as dust, cold weather, and laughing, that would trigger her coughing fits. She reported that, during this ten-year period, she did not have any episodes of fever, chest pain or dyspnea, but she occasionally presented wheezing, and she had once produced bloody sputum. The patient had a family history of asthma, allergic rhinitis, and emphysema. She also had a personal history of allergic rhinitis (during adolescence). The clinical examination revealed rhonchi and wheezing, both of which were bilateral and diffuse. Additional examinations showed the following: normal spirometry results, positivity for A. fumigatus in immediate cutaneous reaction allergy testing (skin prick test); eosinophilia (13%) in the blood workup; total serum IgE levels higher than 1000 ng/ml; and radioallergosorbent test (RAST) class 3 in the determination of specific IgE for A. fumigatus. On the chest X-ray, glove-finger shadows were observed in the right superior third (Figure 1). The high-resolution computed tomography scan revealed central bronchiectasis (Figure 2). The criteria for a diagnosis of ABPA are as follows: asthma; eosinophilia; opacities in the lung; central bronchiectasis accompanied by IgE > 1000 ng/ml; positive skin prick test; and class 3 RAST positivity for A. fumigatus. Having met these criteria, the patient was treated with 50 mg/day of prednisone for four weeks, and two inhalations of salbutamol spray totaling 100 µg every six hours. The prednisone dose was gradually decreased on a weekly basis over the eight weeks that followed. By the end of the treatment, the coughing, expectoration, and wheezing, as well as the amount of mold eliminated from the bronchi, had been reduced. In addition, the pulmonary auscultation findings were normal, the RAST result for A. fumigatus was class 2, the degree of eosinophilia decreased (to 4%), and total serum IgE was 608 ng/ml.
Posted on: Mon, 21 Apr 2014 16:17:57 +0000
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