Jiang Nannan, Xiang Li
Department of Allergy, Beijing Children's Hospital, Children's National Medical Center, Beijing, China.
Asia Pac Allergy. 2020 Jul 13;10(3):e27. doi: 10.5415/apallergy.2020.10.e27. eCollection 2020 Jul.
Allergic bronchopulmonary aspergillosis (ABPA) is a disease of the lungs resulting from a hypersensitivity reaction to . The disease remains underdiagnosed and as many as 57% of patients are misdiagnosed as pulmonary tuberculosis, pneumonia, pulmonary abscess in China. Here we report the case of a 13-year-old girl with ABPA who presented with productive cough, wheezing, bronchiectasis and decline in lung function, total IgE was 25,180 KU/L, -specific IgE was 34.7 kUA/L. Chest high-resolution computed tomography (CT) showed infiltration, central bronchiectasis, and high-attenuation mucus in the left lower lobe and lingula. On bronchoscopy, a large amount of purulent material and brownish sputum plugs were seen. This case has been diagnosed as pneumonia 3 times before the ABPA diagnosis. For the treatment, corticosteroid (prednisone 0.5 mg/kg/day) plus itraconazole (200 mg, twice a day) were initiated. The girl responded well to the therapy. Two weeks later, she was free of symptoms. Lung function nearly improved to normal. One month later, peripheral eosinophil percentage and IgE decreased to 0.7% and 1,3451 KU/L (46% reduction), respectively. However, the trend of specific IgE persistently increased during treatment (from 34.7 KU/L to above 100 KU/L). Chest CT showed improvement in pulmonary infiltration. The present case emphasizes the importance of considering the diagnosis of ABPA in children with uncontrolled pneumonia, hypereosinophilia, and bronchiectasis with a previous history of asthma. Total serum IgE is a useful marker of disease activity and success of therapy while the serum -specific IgE has limited utility in the follow-up of patients with ABPA.
变应性支气管肺曲霉病（ABPA）是一种因对……产生超敏反应而导致的肺部疾病。在中国，该疾病仍未得到充分诊断，多达57%的患者被误诊为肺结核、肺炎、肺脓肿。在此，我们报告一例13岁患有ABPA的女孩，她表现为咳痰、喘息、支气管扩张和肺功能下降，总IgE为25,180 KU/L，特异性IgE为34.7 kUA/L。胸部高分辨率计算机断层扫描（CT）显示左肺下叶和舌叶有浸润、中心性支气管扩张以及高密度黏液。在支气管镜检查中，可见大量脓性物质和褐色痰栓。该病例在ABPA诊断之前曾3次被诊断为肺炎。治疗方面，开始使用皮质类固醇（泼尼松0.5 mg/kg/天）加伊曲康唑（200 mg，每日两次）。该女孩对治疗反应良好。两周后，她症状消失。肺功能几乎恢复正常。一个月后，外周嗜酸性粒细胞百分比和IgE分别降至0.7%和1,3451 KU/L（降低46%）。然而，治疗期间特异性IgE持续升高（从34.7 KU/L升至100 KU/L以上）。胸部CT显示肺部浸润有所改善。本病例强调了在患有未控制的肺炎、嗜酸性粒细胞增多症以及有哮喘病史的支气管扩张患儿中考虑ABPA诊断的重要性。血清总IgE是疾病活动度和治疗成功与否的有用标志物，而血清特异性IgE在ABPA患者的随访中效用有限。
