Bronchial biopsy in allergic bronchopulmonary aspergillosis without clinical asthma]

A 24-year-old man who had had bronchial asthma between the ages of 10 and 12 years was admitted to our hospital on October 10, 2000. In May 1999, he had received antituberculosis therapy for left upper lobe infiltrate, which resolved two months later. Chest radiography on admission showed recurrence of the left upper lobe infiltrate. He complained of cough and low grade fever. Thoracic CT demonstrated gloved-finger shadows in the left upper lung field, as well as central bronchiectasis. Wheeze was not ausculated, and flow volume curve revealed no obstructive changes. Total IgE was markedly increased (6,084 IU/ml), and IgE RAST was positive for multiple allergens including Aspergillus species and precipitating antibody test against Aspergillus fumigatus was also positive. Bronchofiberscopy revealed mucoid impaction at the left B1 + 2, and culture of lavage fluid demonstrated Aspergillus fumigatus. A bronchial biopsy at the orifice of the left upper lobe bronchus revealed thickening of the basement membrane, eosinophil infiltration, and marked hypertrophy of the mucus glands. The diagnosis was allergic bronchopulmonary aspergillosis (ABPA), and 30 mg prednisolone was initiated and tapered. The infiltrate detected on chest radiography was resolved. Eight months later, asthmatic symptoms were observed, and Fluticasone dipropionate administration was started. However, the infiltration seen in the chest radiographs have not recurred until now. Asthmatic inflammation of the bronchial mucosa was demonstrated in a case of ABPA without clinical asthma.