A Case of Allergic Bronchopulmonary Aspergillosis (ABPA) in a Patient with a History of Cocaine Use and Tuberculosis

Abstract

Aspergillosis refers to a spectrum of disorders that can occur due to colonization with the Aspergillus fungus. Allergic bronchopulmonary aspergillosis (ABPA) is an airway hypersensitivity reaction to the fungus that is almost exclusively seen in patients with cystic fibrosis or asthma. Here, we present a case of ABPA in a patient with a history of chronic cocaine use and tuberculosis and no history of asthma or cystic fibrosis. The patient had presented with progressively worsening dyspnea for three months as well as a 20-pound weight loss. Diagnosis was made with an elevated IgE against Aspergillus and chest CT findings, which included bronchiectasis and tree-in-bud nodular opacities. The patient was treated with IV methylprednisolone followed by a 4-day course of oral prednisone, with significant improvement. It is our hope to make healthcare providers aware of the potential presence of ABPA in chronic cocaine users and patients with tuberculosis, both of which are not traditionally associated with this condition.

Misdiagnosis of persistent asthma of a patient suffering from acute bronchopulmonary aspergillosis (ABPA)

“…ABPA is an immunologic pulmonary disease due to a hypersensitivity reaction to a fungus called Aspergillus fumigatus . Clinically, the patients that suffer from this disease present with chronic asthma, recurrent pulmonary infiltrates and bronchiectasis [ 1 ].…”

“…Allergic bronchopulmonary aspergillosis is an airway hypersensitivity reaction to the fungus A. fumigatus antigens that is almost seen exclusively in patients with asthma and cystic fibrosis. Only a minority of the population develop this condition after the aspergillus hypersensitivity (which is defined as the presence of cutaneous hypersensitivity to the above-mentioned fungus) [ 1 , 3 ].…”

“…The prevalence of this disease among patients with asthma is approximately 1–2% but slightly higher in patients that suffer from cystic fibrosis being about 2–9% [ 1 , 4 ]. For those that are corticosteroids-dependent asthmatics, the prevalence is 7–14% [ 11 ].…”