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An Atypical Presentation of Allergic Bronchopulmonary Aspergillosis

Summary

A 57-year-old man without prior lung problems developed a persistent cough and breathing difficulties that didn’t respond to antibiotics. Imaging showed his lung had collapsed and fluid had accumulated around it, raising concerns about cancer. However, bronchoscopy revealed the collapse was caused by thick mucus plugs filled with Aspergillus fungus rather than cancer. After treatment with antifungal medication and steroids, the patient fully recovered with his lung re-expanding and fluid resolving.

Background

Allergic bronchopulmonary aspergillosis (ABPA) is an immune-mediated hypersensitivity reaction to Aspergillus fumigatus that typically occurs in patients with asthma or cystic fibrosis. Presentation with lobar atelectasis or pleural effusion is rare and can mimic malignancy.

Objective

To report an uncommon case of ABPA presenting with pleural effusion and lobar collapse in a patient without pre-existing lung disease, highlighting the importance of considering ABPA in the differential diagnosis of unexplained pleural effusions.

Results

Bronchoscopy revealed complete obstruction of the left upper lobe bronchus by thick mucus plugs with histopathology and culture confirming Aspergillus fumigatus. Laboratory testing showed marked eosinophilia (1500 cells/µL), elevated total IgE (1432 IU/mL), and positive A. fumigatus precipitins. Treatment with oral prednisolone and itraconazole resulted in full clinical and radiological recovery with sustained remission.

Conclusion

ABPA can rarely present with lobar atelectasis and pleural effusion, even in patients without known chronic lung disease. Early bronchoscopy is essential for diagnosis and exclusion of malignancy, while prompt corticosteroid and antifungal therapy prevents long-term complications. ABPA should be considered in the differential diagnosis of unexplained or eosinophilic pleural effusions.
  • Published in:Cureus,
  • Study Type:Case Report,
  • Source: PMID: 41450377, DOI: 10.7759/cureus.97627
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