Abstract

Allergic bronchopulmonary aspergillosis is a hypersensitivity disease of the lungs which occurs as a result of allergic late phase reactions of an inflammatory response to Aspergillus fumigatus antigenes. Asthma, peripheral blood eosinophilia, antibody reaction to aspergillus, positive skin tes,t elevated total serum immunoglobulin (Ig)E, specific IgE and IgG and proximal bronchiectasis are major diagnostic criteria. A 48 year old woman who showed no response to antibiotic drug treatment for pneumonia for 6 months, was admitted for a mediastinal lymph node (MLN) biopsy which had been observed on further examination. Laboratory findings showed elevated eosinophils in CBC 2100/ mm3, elevated IgE levels 205.1 IU/ml and specific IgE to aspergillus antigen 0.35 IU/ml. The thorax CT scan showed a chain of mediastinal lymphadenopathy (MLA) with the largest having a short diameter of 6-7 mm, probably due to a reactive response, proximal bronchiectasis and large bronchi almost filled with dense material. The Prick skin test was positive with 3x3 mm for Aspergillus. The patient was diagnosed as ABPA due to prior asthma disease, eosinophilia, elevated serum IgE levels, central bronchiectasis and positive reaction to skin Prick test for Aspergillus antigens. For this reason she was not scheduled for MLN biopsy. Although MLA had not been included in the radiological findings criteria for ABPA, it is possible to see MLA in ABPA as in our case. In the differential diagnosis of MLA diseases, ABPA should be considered as a possibility. The patient should be assessed thoroughly to avoid needless invasive intervention. (Tur Toraks Der 2011; 12: 114-6)