1. Eosinophilic Granulomatosis with Polyangiitis preceding allergic bronchopulmonary aspergillosis.
- Author
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Lee W, Teo FS, Santosa A, and Teng GG
- Subjects
- Antifungal Agents therapeutic use, Aspergillosis, Allergic Bronchopulmonary diagnosis, Aspergillosis, Allergic Bronchopulmonary drug therapy, Aspergillus fumigatus immunology, Azathioprine therapeutic use, Biomarkers blood, Biopsy, Drug Substitution, Glucocorticoids therapeutic use, Granulomatosis with Polyangiitis diagnosis, Granulomatosis with Polyangiitis drug therapy, Humans, Immunoglobulin E blood, Immunosuppressive Agents therapeutic use, Male, Middle Aged, Tomography, X-Ray Computed, Treatment Outcome, Aspergillosis, Allergic Bronchopulmonary immunology, Granulomatosis with Polyangiitis immunology
- Abstract
A 61-year-old Chinese man with long-standing, stable Eosinophilic Granulomatosis with Polyangiitis (EGPA) and asthma, presented with acute hypoxemia and declining obstructive pulmonary function. Elevated serum IgE levels, positive Aspergillus fumigatus specific IgE and CT findings of central bronchiectasis with small airway mucoid impaction confirmed new development of Allergic Bronchopulmonary Aspergillosis (ABPA). The maintenance therapy for EGPA, azathioprine, was discontinued. Prednisolone 0.5 mg/kg/day and Itraconazole improved his symptoms and IgE levels. To our knowledge, ABPA occurring in a patient with EGPA has not been reported. Differentiation of EGPA with asthmatic flare vs ABPA vs asthma with aspergillus hypersensitivity is discussed. Heightened Th2 immunity where eosinophils play a central role may link these conditions.
- Published
- 2015