Allergic bronchopulmonary Aspergilloma
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Mnemonic to remember the key features of Allergic Bronchopulmonary Aspergillosis (ABPA): “SPADE.”
S: Serum Ig E elevation > 1000 IU/ml is a hallmark feature of ABPA due to allergic sensitization to Aspergillus. Alternatively Skin test reactivity can be used for diagnosis confirmation.
P: Pulmonary findings like infiltrates on CXR and CT scan shows Central Bronchiectasis and Positive Precipitins to aspergillus
A: Asthma association though in some cases patient may has cystic fibrosis. Aspergillus colonization of airways is responsible for this presentation.
D: Dyspnea: Dyspnea, or shortness of breath, is a common symptom of ABPA, often accompanied by coughing, wheezing, and sputum production.
E: Eosinophilia
For management of ABPA, itraconazole and systemic steroids are used. Alternatively, Omalizumab is used. The rationale for using itraconazole is to reduce antigenic stimulation.
Comparison of ABPA versus Acute eosinophilic pneumonia
| ABPA | Allergic interstitial pneumonitis | |
| Etiology | Allergic reaction to the fungus Aspergillus | Unknown, smoking initiation, Vaping |
| Clinical Presentation | Brown sputum plugs in an asthmatic or cystic fibrosis | Acute respiratory distress, fever, cough, and shortness of breath. The onset is rapid, often within a few days. Chest X-rays may show diffuse infiltrates.
|
| Labs | Elevated serum IgE levels, eosinophilia, and positive Aspergillus-specific IgE and IgG antibodies | Eosinophilia and BAL showing eosinophils |
| Treatment | Steroids plus antifungals | Steroids |