Here, we reported a case of delayed diagnosis of allergic bronchopulmonary aspergillosis (ABPA) with low serum IgE and normal Aspergillus fumigatus-specific IgE levels. During the course of the disease, the patient (female, 55 years old) had imaging manifestation of mass shadow and significant elevation of carcinoembryonic antigen, leading to suspicion of a lung tumor. Later, transbronchial lung biopsy tissue culture showed Aspergillus fumigatus. Combined with the history, clinical characteristics and imaging, she was diagnosed with allergic bronchopulmonary aspergillosis combined with invasive pulmonary aspergillosis. As the diagnostic criteria for ABPA do not cover all patients with ABPA, in rare cases where immunological evidence is insufficient, a combination of clinical and imaging features is required for early diagnosis and treatment.
本文介绍1例变应性支气管肺曲霉病（ABPA）血清总IgE及烟曲霉特异性IgE水平正常而延迟诊断的患者。患者女，55岁，病程中影像学曾出现过肿块影，合并血癌胚抗原明显升高，疑诊为肺肿瘤。后经支气管肺活检组织培养出烟曲霉，结合病史、临床、影像学表现，诊断为ABPA合并侵袭性肺曲霉病。鉴于ABPA诊断标准不能覆盖所有患者，在免疫学证据尚不充足的少见情况下，需结合临床、影像学表现，以进行早期诊断及治疗。.

暂无摘要。

Pulmonary infiltrates with eosinophilia are a heterogeneous group of disorders that are characterized by pulmonary infiltrates on chest radiograph and elevated levels of eosinophils in the peripheral blood. Among patients with these disorders, reports of either allergic bronchopulmonary aspergillosis (ABPA) or tropical pulmonary eosinophilia (TPE) are common. However, the simultaneous occurrence of ABPA and TPE is not often reported. We present the case of a young man with a history of asthma who was diagnosed with ABPA and TPE. Initially, the patient exhibited a partial response to treatment of ABPA, but persistent symptoms and eosinophilia led to suspicion and subsequent diagnosis of TPE. With implementation of antifilarials and steroids, the patient experienced satisfactory clinical and serological improvements. This case underscores the importance of considering multiple diagnoses in patients with overlapping symptoms and highlights the need for comprehensive management strategies in complex lung diseases.

UNASSIGNED: Fatal asthma is a rapidly progressing and highly fatal form of asthma. Mechanical ventilation, although necessary for respiratory support, can exacerbate the condition and lead to ventilator-associated lung injury. ECMO therapy is crucial in allowing the lungs to rest and recover, as it provides extracorporeal membrane oxygenation.
UNASSIGNED: A 40-year-old man presented with dyspnea following a mountain climb, which rapidly worsened, leading to respiratory failure and loss of consciousness. Despite drug therapy and mechanical ventilation, arterial blood gas analysis showed persistent hypercapnia. After 3 days of ECMO support, the patient was successfully extubated and underwent treatment for Aspergillus infection. Chest CT returned to normal after 3 months of anti-aspergillus therapy.
UNASSIGNED: When drug therapy and mechanical ventilation fail to improve respiratory failure in fatal asthma, prompt initiation of ECMO support is essential to create opportunities for subsequent etiological treatment.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus that occurs in patients with asthma or cystic fibrosis. Here, we report a case of a young female with bronchial asthma who presented to our hospital with worsening breathlessness on exertion. She was diagnosed to have ABPA and was initiated on oral itraconazole while continuing inhaled long acting beta-2 adrenergic agonist and medium dose inhaled corticosteroid (ICS) for her asthma. Three months after initiation of therapy, the patient had significant improvement in breathlessness. However, she had weight gain, facial puffiness, increased facial hair and development of striae on her inner thighs, calf and lower abdomen. Her serum cortisol levels were found to be suppressed and hence a diagnosis of iatrogenic Cushing\'s syndrome was made. Our case describes the potentially serious interaction between ICS and oral itraconazole, a treatment very commonly prescribed in patients with ABPA.

Pulmonary aspergillosis is a well-recognized fungal lung disease caused by the Aspergillus species (especially Aspergillus fumigatus). Allergic bronchopulmonary aspergillosis (ABPA) is milder form of pulmonary aspergillosis compared to other more invasive forms. However, if left untreated, ABPA can cause significant lung damage. We present the case of a 33-year-old man who came with complaints of shortness of breath, chest discomfort, and productive cough. The patient underwent High Resolution Computed Tomography (HRCT) scan of the chest which, suggested the diagnosis of ABPA with secondary tension pneumothorax.

There are no precise data about the effect of Aspergillus infection on lung function other than allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (pwCF). Here, we aimed to determine clinical phenotypes caused by Aspergillus spp. using laboratory and immunologic parameters and to compare Aspergillus phenotypes in terms of pulmonary function tests (PFT) prospectively.
Twenty-three pwCF who had Aspergillus isolation from respiratory cultures in the last year (case group) and 20 pwCF without Aspergillus isolation in sputum (control group) were included. Aspergillus immunoglobulin (Ig)-G, Aspergillus IgE, Aspergillus polymerase chain reaction (PCR), galactomannan, total IgE from blood samples, and Aspergillus PCR and galactomannan from sputum, and skin prick test reactivity to Aspergillus antigen were used to distinguish different Aspergillus phenotypes. Pulmonary functions and frequency of pulmonary exacerbations were evaluated during a 1-year follow-up.
Of 23 pwCF, 11 (47.8%) had Aspergillus colonization, nine (39.1%) had Aspergillus bronchitis, and three (13%) had ABPA. Aspergillus infection was not associated with worse z-scores of forced expiratory volume in the first second (FEV1) (p = 0.612), forced vital capacity  (p = 0.939), and the median FEV 1% decline (0.0%/year vs. -4.7%/year, p = 0.626). The frequency of pulmonary exacerbations in the Aspergillus infected and noninfected groups was similar.
Although Aspergillus spp. Isolation in pwCF was not associated with decreased lung function, a further decline was seen in the ABPA subgroup, and frequent pulmonary exacerbations during the 1-year follow-up.

Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease characterized by a hypersensitivity reaction to Aspergillus fumigatus. Allergic bronchopulmonary aspergillosis is characterized by increased serum IgE levels, peripheral blood eosinophilia and radiographic pulmonary infiltrates, central bronchiectasis, and mucus plugs. Mepolizumab, a monoclonal interleukin (IL)-5 antibody, reduces eosinophilic inflammation and improves symptom control in severe eosinophilic asthma. A 74-year-old male patient arrived at our allergy outpatient clinic complaining of shortness of breath and cough. He had a history of asthma, NSAIDs Exacerbated Respiratory Disease (N-ERD) and endoscopic sinus surgery (ESS) due to chronic sinusitis with nasal polyps (CRSwNPs). At the time of admission to our clinic, his asthma control test (ACT) score was 5. The laboratory test results= eosinophil count (cells/mcL)= 570, total IgE= 3976 IU/mL, Aspergillus-specific IgE= 1.87 kIU/L (>0.35 positive). In the pulmonary function tests, forced expiratory volume in 1s (FEV1) was 28%. Thoracic computed tomography of the patient revealed central cystic bronchiectatic areas and mucus plugs. The patient was diagnosed with ABPA. The case reported here is of a patient diagnosed with severe asthma concomitant with ABPA and N-ERD, who was successfully treated with mepolizumab. Randomized double-blind placebo-controlled studies are needed to evaluate the efficacy of mepolizumab treatment in these patients.

A-55-year-old man who have been working in a Sake (Japanese rice wine) brewer for 27 years, came to the outpatient clinic because cough, dyspnea, and wheeze gradually worsen. These symptoms occurred immediately after exposure to Aspergillus oryzae in the brewing process since age 43. A dust mask was required to reduce these symptoms, but that work was interrupted by exacerbation of these symptoms. These symptoms disappeared when he was away from the on-site work. The SMART therapy using combined inhaler of budesonide (ICS) with formoterol (LABA) was effective to reduce these symptoms. In serological test total IgE antibody and Aspergillus specific IgE antibodies increased, whereas Aspergillus precipitating antibody and Asp f 1 (a major allergen of Aspergillus fumigatus) specific IgE antibody were negative. Eosinophilia in peripheral blood was not observed, and FeNO was not increased. Values of peak expiratory flow was reduced by 20.8% after exposure to Aspergillus oryzae in that work. Lung function test including reversibility test was intact, but FEV1 was fluctuated up to 400mL (15.9%) in the clinical course. Based on these variable clinical manifestations, laboratory data, and lung function test findings, this case was diagnosed as adult-onset atopic (Aspergillus-sensitized) bronchial asthma without allergic bronchopulmonary aspergillosis. Involvement of eosinophilic inflammation is unknown. Allergen may be considered to be Aspergillus oryzae, because these symptoms do not occur in any environment without exposure to Aspergillus oryzae. This patient is the first case of occupational asthma related to Aspergillus oryzae in a Japanese rise wine brewer.

BACKGROUND: Allergic bronchopulmonary candidiasis (ABPC) is an uncommon clinical syndrome associated with immune hypersensitivity to Candida species.
METHODS: The case presentation describes a 58-year-old man with acute respiratory failure and bilateral lung infiltrates. Due to high inflammatory markers and a chest X-ray indicating lung infiltration, he was initially treated for pneumonia with combined antibiotics. Despite comprehensive treatment at the ICU, the patient\'s clinical status deteriorated rapidly, and further investigations provided a rare diagnosis of ABPC. After several days of combined corticosteroid and antifungal therapy, we observed rapid clinical improvement and subsequent resolution of the pulmonary infiltrates.
CONCLUSIONS: This case report presented a rare case of ABPC mimicking bilateral pneumonia and acute respiratory failure. Our case highlighted the importance of prompt corticosteroid and antifungal treatment initiation as it resulted in rapid clinical improvement and a near complete reversal of the bilateral lung infiltrates.