Resolution of allergic bronchopulmonary aspergillosis preceded by allergic fungal rhinosinusitis, without glucocorticoid therapy in an immunocompetent individual: a case report with narrative literature review
Year: 2025
Type: article
Study design: Case Report
Abstract: Allergic bronchopulmonary aspergillosis (ABPA), seen predominantly in patients with uncontrolled bronchial asthma, cystic fibrosis, and immunocompromised patients, can uncommonly occur in an immunocompetent host. Rarely, an ABPA patient can have a preceding or concomitant history of its upper respiratory counterpart, allergic fungal rhinosinusitis (AFRS). The traditional mainstay of ABPA treatment is systemic glucocorticoids. We report a case of ABPA in a woman with a history of AFRS and recurrent atopic rhinitis, but with no previous definitive history of bronchial asthma or cystic fibrosis, that resolved without systemic glucocorticoid therapy. A 52-year-old female patient, a non-smoker, previously operated for AFRS, presented to the outpatient department with fever with chills, right-sided pleuritic type of chest pain, and cough with brown-black expectoration. The absolute eosinophil count was 1360. Serum baseline IgE was >2500. A chest X-ray revealed consolidation in the right middle zone. High-resolution computed tomography (HRCT) of the thorax revealed linear branching hyperdense content in a few of the dilated bronchi. Fiber-optic bronchoscopy confirmed thick mucus plugging at the lateral segment of the right middle lobe, pathognomonic of ABPA with high-attenuation mucus (ABPA-HAM). Oral Itraconazole monotherapy 200 mg twice daily for one day, followed by 100 mg twice daily for a total period of four months’ duration, had no significant adverse events during treatment. C-reactive protein decreased significantly by 2 weeks, total serum IgE levels by 2 months; and repeat chest X-ray at 6 months showed complete resolution of pulmonary infiltrates. This case report corroborates recent revised 2024 ISHAM-ABPA working group guidelines advocating Itraconazole monotherapy alone for treating acute ABPA.
Authors: Prasanth P. Dev, Jophy Varghese, Rajeev Z. Kompithra, Sudeep K., George Joseph, Joison Abraham
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411722428