Central Bronchiectasis in Allergic Bronchopulmonary Aspergillosis

Abstract

Allergic bronchopulmonary aspergillosis (ABPA), seen in 3% to 5% of the asthmatic population, is a hypersensitivity disease of the lungs characterized by a type I, type III, and type IV allergic response to Aspergillus antigens, almost always to that of A. fumigatus. If untreated, permanent lung damage in the form of bronchiectasis and fibrosis ensues. Recurrent pulmonary opacities on chest radiography, peripheral blood eosinophilia, and refractory asthma should raise suspicion for ABPA. A positive skin test for A. fumigatus and elevated levels of serum IgE strongly suggest the diagnosis of ABPA. The demonstration of central bronchiectasis is also highly suggestive of ABPA, particularly when high attenuation mucoid impaction is encountered. Corticosteroid therapy remains the cornerstone of treatment.