An asthmatic child with allergic bronchopulmonary aspergillosis (ABPA)

Allergic bronchopulmonary aspergillosis (ABPA) results from a TH2hypersensitivity lung disease in response to bronchial colonization ofAspergillus fumigatus in the respiratory tract. ABPA is a very rare disease inthe pediatric population; the prevalence is anticipated to be about 1–2% inadult asthma patients and 2–15% in cystic fibrosis patients. In pediatric asthmapatients, only rare case reports on ABPA have been published. We presenta case of a 12-year-old boy admitted to our hospital with worsening (mildpersistent) asthma symptoms such as a recurrent cough, episodic wheezing,and dyspnea for the last two years. He was diagnosed with pneumoniaseveral times and suspected of having tuberculosis during this time. ChestX-ray showed bilaterally perihilar opacities and computed tomography findingsrevealed central bronchiectasis. With the clinical and laboratory findings, thepatient fulfilled 7/8 major diagnostic criteria for ABPA. Treatment with oralcorticosteroids and itraconazole was effective. To the best of our knowledge,this is the first reported case of pediatric ABPA with previously documentedasthma from Turkey.

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1. Knutsen AP, Bush RK, Demain JG, et al. Fungi and allergic lower respiratory tract diseases. J Allergy Clin Immunol 2012; 129: 280-291; quiz 292-293.

2. Hinson KF, Moon AJ, Plummer NS. Broncho-pulmonary aspergillosis; a review and a report of eight new cases. Thorax 1952; 7: 317-333.

3. Knutsen AP. Allergic bronchopulmonary aspergillosis in asthma. Expert Rev Clin Immunol 2017; 13: 11-14.

4. Mussaffi H, Greif J, Kornreich L, et al. Severe allergic bronchopulmonary aspergillosis in an infant with cystic fibrosis and her asthmatic father. Pediatr Pulmonol 2000; 29: 155-159.

5. Shin JE, Shim JW, Kim DS, Jung HL, Park MS, Shim JY. Case of seropositive allergic bronchopulmonary aspergillosis in a 10-year-old girl without previously documented asthma. Korean J Pediatr 2015; 58: 190- 193.

6. Kumar R, Gaur SN. Prevalence of allergic bronchopulmonary aspergillosis in patients with bronchial asthma. Asian Pac J Allergy Immunol 2000; 18: 181-185.

7. Singh M, Das S, Chauhan A, et al. The diagnostic criteria for allergic bronchopulmonary aspergillosis in children with poorly controlled asthma need to be re-evaluated. Acta Pædiatrica 2015; 104, e206-e209.

8. C h e t t y A , B h a r g a v a S , J a i n R K . A l l e r g i c bronchopulmonary aspergillosis in Indian children with bronchial asthma. Ann Allergy 1985; 54: 46-49.

9. Eaton T, Garrett J, Milne D, Frankel A, Wells AU. Allergic bronchopulmonary aspergillosis in the asthma clinic. A prospective evaluation of CT in the diagnostic algorithm. Chest 2000; 118: 66-72.

10. Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol 2013; 51: 361-370.

11. Wang JL, Patterson R, Rosenberg M, Roberts M, Cooper BJ. Serum IgE and IgG antibody activity against Aspergillus fumigatus as a diagnostic aid in allergic bronchopulmonary aspergillosis. Am Rev Respir Dis 1978; 117: 917-927.

12. Chauhan B, Santiago L, Hutcheson PS, et al. Evidence for the involvement of two different MHC class II regions in susceptibility or protection in allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol 2000; 106: 723-729.

13. D'Urzo AD, McIvor AR. Case report: allergic bronchopulmonary aspergillosis in asthma. Can Fam Physician 2000; 46: 882-884.

14. Rosenberg M, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med 1977; 86: 405-414.

15. Greenberger PA, Patterson R. Allergic bronchopulmonary aspergillosis and the evaluation of the patient with asthma. J Allergy Clin Immunol 1988; 81: 646-650.

16. de Almeida MB, Bussamra MH, Rodrigues JC. Allergic bronchopulmonary aspergillosis in paediatric cystic fibrosis patients. Paediatr Respir Rev 2006; 7: 67-72.

17. Ionescu MD, Balgradean M, Marcu V. Allergic bronchopulmonary aspergillosis in patient with cystic fibrosis - a case report. Maedica (Buchar) 2014; 9: 387-390.

18. De H, Azad SM, Giri PP, Pal P, Ghosh A, Maitra A. Two cases of non-cystic fibrosis (CF) bronchiectasis with allergic bronchopulmonary aspergillosis. Respir Med Case Rep 2017; 20: 68-71.

19. Kumar R. Mild, moderate, and severe forms of allergic bronchopulmonary aspergillosis: A clinical and serologic evaluation. Chest 2003; 124: 890-892.

20. Kumar R, Goel N. Allergic bronchopulmonary aspergillosis: A clinico-serological correlation with radiologic profile. J Asthma 2013; 50: 759-763.

21. Öner Erkekol F, Bavbek S, Göksel Ö ve ark. Allerjik bronkopulmoner aspergilloz: 3 olgu nedeniyle. Tüberküloz ve Toraks Dergisi 2007; 55: 418-428.

22. Agarwal R, Khan A, Aggarwal AN, Gupta D. Link between CFTR mutations and ABPA: A systematic review and meta-analysis. Mycoses 2012; 55: 357-365.

23. Patterson R, Greenberger PA, Radin RC, Roberts M. Allergic bronchopulmonary aspergillosis: Staging as an aid to management. Ann Intern Med 1982; 96: 286-291.

24. Kirsten D, Nowak D, Rabe KF, Mgnussen H. Diagnosis of bronchopulmonary aspergillosis is often made too late. Med Klin (Munich) 1993; 88: 353-356.

25. Greenberger PA. Clinical aspects of allergic bronchopulmonary aspergillosis. Front Biosci 2003; 8: s119-s127.

26. Santos A, Loureiro G, Faria E, Chieira C. Itraconazole, an effective adjunctive treatment for allergic bronchopulmonary aspergillosis. J Investig Allergol Clin Immunol 2009; 19: 404-408.

27. Agarwal R. Allergic bronchopulmonary aspergillosis. Chest 2009; 135: 805-826.

28. Davidsen JR, Madsen PH, Laursen CB. Uncontrolled asthma and recurring pulmonary opacities: Just asthma? BMJ Case Rep 2014; 2014.