Case Report

A Case of Allergic Bronchopulmonary Aspergillosis Leading to Pneumonia with Unusual Organisms

Authors: Brown James McCallum, MD, David Amrol, MD, Joseph Horvath, MD, Nadeem Inayat, MD, Rohit Talwani, MD


We describe the case of a 50-year-old male with a history of asthma and seizure disorder who presented with a 5-month history of dyspnea. The patient had been treated with multiple courses of antibiotics for presumed community-acquired pneumonia before being determined to have allergic bronchopulmonary aspergillosis (ABPA) by serologic and radiographic criteria. Inflammation resulting from this disease had potentiated a postobstructive pneumonia caused by Nocardia asteroides and Stenotrophomonas maltophilia. Therapy with corticosteroids, trimethoprim sulfa, and voriconazole failed to prevent subsequent destruction of the right upper lobe and the patient required surgical intervention. The discussion emphasizes the diagnostic criteria for ABPA including historic, serologic, and radiographic findings; staging, and treatment. Other possible diagnoses, such as invasive pulmonary aspergillosis, chronic necrotizing aspergillosis, and hyper-IgE syndrome are also briefly reviewed.

Key Points

* Allergic bronchopulmonary aspergillosis requires a high degree of clinical suspicion for diagnosis.

* Allergic bronchopulmonary aspergillosis is characterized by the constellation of asthma, elevated total serum IgE, immediate cutaneous hypersensitivity to Aspergillus fumigatus,elevated IgG or IgE to Aspergillus fumigatus, and central bronchiectasis.

* Misdiagnosis or delayed diagnosis of ABPA can lead to significant morbidity or mortality.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Hinson KF, Moon AJ, Plummer NS. Broncho-pulmonary Aspergillosis: A Review and a Report of Eight New Cases. Thorax 1952;7:317–333.
2. Greenberger PA. Allergic Bronchopulmonary Aspergillosis. J Allergy Clin Immunol 2002;110:685–692.
3. Soubani AO, Chandrasekar PH. The Clinical Spectrum of Pulmonary Aspergillosis. Chest2002;121:1988–1999.
4. Kumar R. Mild, Moderate, and Severe Forms of Allergic Bronchopulmonary Aspergillosis. Chest2003;124:890–892.
5. Greenberger PA, et al. Allergic Bronchopulmonary Aspergillosis in Patients with and without Evidence of Bronchiectasis. Ann Allergy 1993;70:333–338.
6. Patterson R. Allergic Bronchopulmonary Aspergillosis, A Historical Perspective. Immunol Allergy Clin North Am 1998;18:471–478.
7. Patterson R, Greenberger PA, Radin RC. Allergic Bronchopulmonary Aspergillosis: Staging as an Aid to Management. Ann Intern Med 1982;96:286–291.
8. Angrill J, et al. Bacterial Colonization in Patients with Bronchiectasis: Microbiological Pattern and Risk Factors. Thorax 2002;57:15–19.
9. Frazier AR, Rosenow EC, Roberts GD. Nocardosis: A Review of 25 Cases Occurring During 25 Months. Mayo Clin Proc 1975;50:657–663.
10. Bryan CS, Kohn JE. Principles of Antimicrobial Therapy, and Antibacterial Drugs. In Bryan CS, ed. Infectious Disease in Primary Care. Philadelphia, W. B. Saunders Co. 2002, 1st ed, pp 459.
11. Horvath JA, Dummer S. The Use of Respiratory-Tract Cultures in the Diagnosis of Invasive Pulmonary Aspergillosis. Am J Med 1996;100:171–178.
12. Saraceno JL, et al. Chronic Necrotizing Pulmonary Aspergillosis. Chest 1997;112:541–548.
13. Grimsbacher B, et al. Hyper-IgE Syndrome with Recurrent Infections- An Autosomal Dominant Multisystem Disorder. N Engl J Med 1999;340:692–702.
14. Eppinger TM, et al. Sesitization to Aspergillus Species in the Congenital Neutrophil Disorders Chronic Granulomatous Disease and hyper IgE Syndrome. J Allergy Clin Immunol 1999;104:1265–1272.
15. Fink JN. Allergic Bronchopulmonary Aspergillosis. Chest 1985;87:81S–84S.
16. Leon EF, Craig TJ. Antifungals in the Treatment of Allergic Bronchopulmonary Aspergillosis. Ann Allergy Asthma Immunol 1999;82:511–517.
17. Herbrecht R, et al. Voriconazole vs. Amphotericin B for Primary Therapy of Invasive Aspergillosis. N Engl J Med 2002;347:40.