Clinical analysis of 34 cases of allergic bronchopulmonary aspergillosis

Objective To summarize the clinical features of allergic bronchopulmonary aspergillosis (ABPA), in order to improve the diagnosis and treatment of ABPA. Methods The clinical data of 34 patients who were diagnosed with ABPA and hospitalized in the Peking Union Medical College Hospital from January 2013 to December 2016 were retrospectively analyzed, including clinical manifestations, laboratory findings, and auxiliary examinations. Results There were 11 males and 23 females, aging from 13 to 83 years old, mean age was (47.1±19.8) years old.All the 34 patients presented with cough and wheeze (n=34), sputum production (n=31), sputum plugging (n=6), dyspnea (n=24), hemoptysis (n=4), chest pain (n=2), and fever (n=11). All the 34 patients had increased serum total IgE level.29 patients had increased eosinophil (EOS) count in peripheral blood and five patients had increased EOS proportion in bronchoalveolar lavage fluid (BALF).25 patients had increased serum Aspergillus fumigatus (AF)-specific IgE level and 11 patients had increased AF-specific IgG level.Aspergillus skin test was positive in two patients.Chest CT was characterized by multiple patchy, strip shadows, central cylindrical bronchiectasis and high-density mucous plugging in both lungs.Before diagnosed with ABPA, 19 patients were misdiagnosed as bronchial asthma, six cases as tuberculosis, five cases as pulmonary infection and one case as eosinophilic pneumonia.21 patients were treated with oral corticosteroids and itraconazole. Conclusions ABPA is easily misdiagnosed as other diseases and recurrent asthma is the main clinical characteristic.Central cylindrical bronchiectasis and high-density mucous plugging are the main characteristics on chest CT.EOS count in peripheral blood and BALF, serum total IgE level, serum AF-specific IgE/IgG levels are all increased.Oral glucocorticoids combined with antifungal agents are effective for ABPA. Key words: Allergic bronchopulmonary aspergillosis; Asthma; Diagnosis; Treatment