Experience with allergic bronchopulmonary aspergillosis: some unusual features

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Abstract
The clinical and immunologic features of 10 patients with allergic bronchopulmonary aspergillosis (ABPA), observed over periods varying from 12 mo. to 10 yr, are reported. Acute attacks of ABPA were characterized by several, or all of the following: increased cough and sputum, hemoptysis, pleuritic pain, expectoration of sputum plugs and increasing airways obstruction. Peripheral blood eosinophila and acutely elevated serum IgE levels were seen in all patients during acute attacks, sputum eosinophilia and recovery of Aspergillus in sputum was less common. Blood eosinophilia was not present in all attacks of ABPA and sputum eosinophilia varied similarly from one attack to another. Six patients with previously documented multiple precipitin lines had no demonstrable precipitins to Aspergillus on several occasions between attacks, 3 of these patients were also negative during attacks. Of the 6 patients, 5 again developed positive precipitin lines. The total number of episodes in these 10 patients was 52, 3 patients have had > 9 acute attacks of ABPA. There is no seasonal variation in this group of patients. Since diagnosis, only 3 patients had an attack-free interval > 12 mo. Two patients are steroid-dependent because of severe asthma, and 9 have symptoms of bronchiectasis.