Allergic bronchopulmonary aspergillosis: a case report.

M S Lin, J J Hwang, I W Chong, M S Tsai
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Abstract

Aspergillus-associated pulmonary diseases are aspergilloma, invasive aspergillosis, and allergic bronchopulmonary aspergillosis. Allergic bronchopulmonary aspergillosis is caused by a complex of immunologic reactions to the presence of the Aspergillus species colonizing the bronchial trees. The disease is not common in Taiwan. The major diagnostic criteria for allergic bronchopulmonary aspergillosis are 1) bronchial asthma, 2) pulmonary infiltration, 3) peripheral eosinophilia, 4) positive skin test to Aspergillus fumigatus, 5) serum precipitin to Aspergillus fumigatus, 6) elevated serum Ig E, and 7) central bronchiectasis. We report a case who has had a chronic asthmatic-like cough for 5 years. He worked in a silo for two years before he was troubled by the disease. He was admitted to hospitals four times in the past, and received five bronchoscopic examinations and one open lung biopsy without definite diagnosis. Sputum eosinophilia directed our attention to the differentiation of eosinophilic lung diseases. A bronchogram which revealed central brochiectasis helped us to make the diagnosis of allergic bronchopulmonary aspergillosis, despite negative sputum culture for Aspergillus fumigatus and negative serum precipitin to Aspergillus fumigatus.

过敏性支气管肺曲霉病1例。
曲霉相关的肺部疾病有曲霉瘤、侵袭性曲霉病和过敏性支气管肺曲霉病。过敏性支气管肺曲霉病是由曲霉种定植在支气管树的存在引起的复杂的免疫反应引起的。这种病在台湾并不常见。变应性支气管肺曲霉病的主要诊断标准为:1)支气管哮喘,2)肺浸润,3)外周血嗜酸性粒细胞增多,4)烟曲霉皮试阳性,5)烟曲霉血清沉淀,6)血清Ig E升高,7)中枢性支气管扩张。我们报告一个患有慢性哮喘样咳嗽5年的病例。他在一个筒仓里工作了两年才被疾病困扰。他过去曾四次住院,接受了五次支气管镜检查和一次开放式肺活检,但没有明确的诊断。痰嗜酸性粒细胞增多引起了我们对嗜酸性粒细胞肺疾病的注意。支气管造影显示中枢性支气管扩张帮助我们诊断过敏性支气管肺曲霉病,尽管痰培养呈烟曲霉阴性,血清沉淀呈烟曲霉阴性。
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