Allergic bronchopulmonary aspergillosis: still a mirage or ignorance.

1 of 2 DESCRIPTION A 30-year-old female referred to our department as case of suspected multi-drug resistant tuberculosis with drug induced liver injury. She was on irregular antitubercular treatment (ATT) for past 2.5 years without improvement as prescribed by different physicians. Sputum examination for acid fast bacilli (AFB) was never done. Physical examination revealed bilateral polyphonic rhonchi. Sputum for AFB was negative on 2 consecutive days. Sequential x-ray showed typical fl eeting shadows ( fi gure 1A–H ). CT thorax revealed central bronchiectasis with toothpaste like hyper intense mucous impaction ( fi gure 2A,B . Total serum IgE-2700 IU/ml, skin prick test for Aspergillus spp. was positive ( fi gure 2C ]. Final diagnosis ‘Allergic bronchopulmonary aspergillosis’ (ABPA). Prednisolone 0.5 mg/kg was given once daily, within 1 month patient’s symptoms improved signifi cantly. The patient was lost to followup and stopped treatment due to pregnancy and came back after 9 months with chest x-ray ( fi gure 1H ) showing infi ltrates on right side. ABPA is an immune mediated infl ammatory syndrome caused by hypersensitivity to a fungus, Aspergillus fumigates . 1 ABPA may mimic tuberculosis. 2 So diagnosis can be made on the basis of a combination of clinical, immunological and radiological fi ndings but currently presence of high attenuation mucus is considered pathognomic of ABPA. 3