Different Forms of Allergic Bronchopulmonary Aspergillosis Encountered in Two Patients: ABPA-seropositive and ABPA-central Bronchiectasis

Two female patients, aged 30 and 46 years, with allergic broncho­pulmonary aspergillosis (ABPA) are presented. Both patients had asthma. In the first patient, the diagnosis of ABPA-seropositive was made at an early stage. The diagnosis was based on a positive Asper­gillus skin prick test, positivity for Aspergillus fumigatus IgG, IgE an­tibodies, presence of Aspergillus precipitating antibody and incre­ased total serum IgE (>4000 lU/ml). There were no signs of pulmo­nary infiltration or bronchiectasis and corticosteroid therapy was initiated in this parly phase. In the second patient, a diagnosis of ABPA-central bronchiectasis was made upon finding that the As­pergillus skin prick test and Aspergillus fumigatus IgE antibody test were positive and upon locating central bronchiectasis on high-re- solution CT scans. Total serum IgE (2643 lU/ml) was also increased and peripheral eosinophilia (1570/mm3) was present. Corticostero­id therapy was started at this relatively advanced stage. It was stressed that to exclude ABPA, the Aspergillus skin prick test should be applied in patients with asthma if peripheral eosinophilia is prominent or total IgE > 1000 ng/ml is present. Patients with po­sitive Aspergillus fumigatus skin prick tests must be investigated for a diagnosis of ABPA-seropositive. Damage in the airways and end­stage lung disease may be prevented with appropriate treatment of patients with ABPA in the early stage.