A Case of Allergic Bronchopulmonary Aspergillosis with Pulmonary Atelectasis Free of Asthmatic Symptoms.

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We report a rare case of allergic bronchopulmonary aspergillosis (ABPA) with pulmonary atelectasis and free of asthmatic symptoms.A 65-year-old female was admitted to Sawara Hospital on October 28, 1992 because of a dry cough. At the time of admission, phisical examination revealed no abnormal findings. Laboratory examinations showed only a peripheral eosinophilia, and the chest X-ray film showed an infiltration shadow in the left upper lobe. The patient was treated with 400mg/day of clarithromycin for 8 days, but no clinical improvement was seen. In addition, the chest X-ray film showed pulmonary atelectasis in the left upper lobe. Initial broncho-fiberscopy examination revealed whitish-yellow spots on the wall of the left upper bronchus. Aspergillus fumigatus was isolated from the biopsy specimen. Total IgE and specific IgE measured by a RAST test were elevated to 15, 130IU/ml and 22.8UA/ml, respectively. The precipitating antibody against aspergillus antigen was positive.The patient was then treated and cured with a clearance of the broncho-obliteration, and with a daily dose of fluconazole (FLCZ) 400mg for 40 days. The early elimination of the broncho-obliteration was more effective because the MIC of FLCZ was 100μg/ml.
日本医真菌学会の論文