Allergic Bronchopulmonary Aspergillosis, a Masquerader: Unveiling a Case of Nonresolving Pneumonia in an Asthmatic Patient.

Abstract

Background: Allergic bronchopulmonary aspergillosis (ABPA) is an immune-mediated hypersensitivity reaction to Aspergillus, a common environmental fungus. It is typically seen in asthmatic patients and those with cystic fibrosis. Lack of clinical suspicion and misdiagnosis often make the management of this condition difficult.

Case description: We are reporting a case of ABPA that was diagnosed and managed at Divisional Railway Hospital, Kharagpur, South Eastern Railway. The patient was a 66-year-old female who presented with fever, cough, and shortness of breath. She had been asthmatic since childhood and was on treatment for the same. On initial evaluation, her clinical and radiological features were suggestive of community-acquired pneumonia and were treated with antibiotics. However, the patient did not show improvement, and asthma also remained poorly controlled despite treatment. This raised the possibility of ABPA in this patient. The International Society for Human and Animal Mycology-ABPA (ISHAM-ABPA) working group criterion was used for making the diagnosis. She was successfully managed with low-dose steroids and itraconazole.

Conclusion: A high index of clinical suspicion is needed for timely detection of ABPA. Features of nonresolving pneumonia in the background of poorly controlled asthma raised the possibility of ABPA in this patient. Misdiagnosis and delay in initiating proper treatment can lead to permanent lung damage, such as bronchiectasis and lung fibrosis, which can even lead to life-threatening complications like cor pulmonale and respiratory failure.