Progressive fungal allergic lung disease, is a common complication of asthma or cystic fibrosis.

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Aetiology

• Aspergillus species: Aspergillus fumigatus
• Underlying asthma (2.5% cases) or cystic fibrosis (15% cases)

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Clinical features

Episodes of bronchial obstruction with mucous plugs leading to coughing fits, pneumonia, consolidation, wheezing, and breathlessness are typical and central bronchiectasis is a characteristic feature.

• Central bronchiectasis (CHARACTERISTIC)

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Diagnosis

Modified ISHAM working group 2013 criteria for diagnosis of ABPA:

1. Predisposing asthma/CF
2. Obligatory criteria:
   • IgE > 1000 IU/mL and
   • Positive immediate skin test or increased IgE antibody to Aspergillus
3. Supportive (≥2) criteria:
   • Eosinophilia > 500
   • Precipitins or increased IgG antibody to Aspergillus
   • Consistent radiographic opacities

Chest radiograph:

• Finger-in-glove sign (CHARACTERISTIC): Tubular and branching tubular opacities that appear to emanate from the hila, said to resemble gloved fingers

HRCT:

• Halo sign “signet-ring appearance”: Localized ground glass appearance representing an area of hemorrhagic infarction surrounding a nodule (invasive aspergellosis)

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Management

• Oral glucocorticosteroids (MAINSTAY, M/effective in acute cases)
• Antifungal agents (chronic use): Ketoconazole, Itraconazole, Voriconazole and posaconazole
• Immunotherapy: Omalizumab (monoclonal antibody to IgE)