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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 241

Allergic bronchopulmonary aspergillosis misdiagnosed & incorrectly treated as pulmonary tuberculosis


1 Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi 110 029; Department of Molecular Medicine, Jamia Hamdard (Deemed-to-be-University), New Delhi 110 062; Department of General Medicine & Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha 442 004, Maharashtra, India
2 Department of Molecular Medicine, Jamia Hamdard (Deemed-to-be-University), New Delhi 110 062, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Surendra K Sharma
Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi 110 029; Department of Molecular Medicine, Jamia Hamdard (Deemed-to-be-University), New Delhi 110 062; Department of General Medicine & Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2419_19

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How to cite this article:
Sharma SK, Upadhyay V. Allergic bronchopulmonary aspergillosis misdiagnosed & incorrectly treated as pulmonary tuberculosis. Indian J Med Res 2020;152, Suppl S1:241

How to cite this URL:
Sharma SK, Upadhyay V. Allergic bronchopulmonary aspergillosis misdiagnosed & incorrectly treated as pulmonary tuberculosis. Indian J Med Res [serial online] 2020 [cited 2021 Jul 30];152, Suppl S1:241. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/241/316854

Patient's consent obtained to publish clinical information and images.


A 22 yr old female was referred to the department of Internal Medicine, All India Institute of Medical Sciences New Delhi, India, in November 2016, with a diagnosis of pulmonary tuberculosis which was not responding to treatment. On interrogation, she had a history of bronchial asthma since childhood. Chest X-ray [Figure 1]A and high-resolution computed tomography of the chest [Figure 1]B revealed bilateral upper lobe opacities (right>left) in the both lung fields. Other parameters were suggestive of allergic bronchopulmonary aspergillosis (ABPA) included absolute eosinophil count :1.86 X103/mm3 [(normal:0.02-0.50 electrical impedance; volume, conductivity, light scatter (VCS)]; Aspergillus fumigatus antibodies panel, IgG: >200 U/mL (reference range <8.0), IgM: 1.35 U/mL (reference range <8.00); A. fumigatus precipitins: 12.90 (kUA/L) (reference range <0.35) and, serum immunoglobulin IgE : 11,223.00 kUA/L (reference range <64) (FEIA). With the diagnosis of allergic bronchopulmonary aspergillosis (ABPA), she was treated with oral prednisolone 60 mg/day which was gradually tapered off over the next six months, itraconazole (200 mg twice daily) and inhalational bronchodilators (steroids and β agonists). She responded significantly to the treatment [Figure 1]C. She was put on metered-dose inhalers and is doing well on follow up till date. In this case, ABPA was misdiagnosed and incorrectly treated as pulmonary TB.
Figure 1: (A) Pre-treatment chest X-ray (posteroanterior view) and (B) high-resolution computed tomography chest showing opacities (asterisks, arrows and circles) in both lung fields due to mucocoeles (right lung>left lung). (C) Post-treatment chest X-ray (posteroanterior view) showing almost clearing of opacities.

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Conflicts of Interest: None.


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