비전형적 천식을 동반한 알레르기성 기관지폐 아스페르길르루스증 1례

Abstract

Recently we experienced an allergic bronchopulmonary aspergillosis with atypical respiratory symptoms. Forty seven years old female was admitted to our hospital because of cough, sputum, right pleuritic pain for 2 weeks. She hsd experienced pneumonia several times, but had been not confirmed any causative organism. On physical examination, breathing sound was decreased over right upper lung, but wheezing and crackle were not heard over both lungs. The chest X ray showed segmental consolidation in right upper lobe, and HRCT showed tubular bronchiectasis and obstruction of right upper lobal bronchus due to mucoid impaction. Allergic skin prick test against Aspergillus fumigatus(Af) and serum precipitin were negative, but intradermal skin test was positive for Af. Specific IgE for Af was positive with class I. Total eosinophil count was 650/mm, total IgE level was more than 3000 IU/ml, ESR was 62mm/hr, and eosinophils in induced sputum was 35%. The tests for sputum acid fast bacilli and sputum cytology for malignancy were negative. The PC20 of bronchial methacholine challenge test was 20.2 mg/ml. Transbronchial lung bi- opsy showed bronchial inflammatory change with infiltration of eosinophils and the existence of fungal hypae. Antibody index for serum IgE Af and IgG Af was 10.2 and 2.1 respectively, comparing with Af sensitive asthma patients.