J Korean Med Sci.  2007 Apr;22(2):365-368. 10.3346/jkms.2007.22.2.365.

Allergic Bronchopulmonary Aspergillosis Coupled with Broncholithiasis in a Non-asthmatic Patient

• Koh WJ
• Han J
• Kim TS
• Lee KS
• Jang HW
• Kwon OJ

• KMID: 1713203
• DOI: http://doi.org/10.3346/jkms.2007.22.2.365

Abstract

Allergic bronchopulmonary aspergillosis (ABPA), an asthmatic disease, is caused primarily by hypersensitivity to Aspergillus species. ABPA is rarely observed in the absence of asthma, which is, in fact, the principle criterion for its diagnosis. Here, we report the case of a 36-yr-old woman without a history of bronchial asthma, who manifested a localized pneumonic consolidation, coupled with broncholithiasis. Pathologic examinations of bronchoscopic biopsy specimens and resected surgical specimens revealed features typical of ABPA. This is a very rare case of ABPA coupled with broncholithiasis in a non-asthmatic individual.

Keyword

Allergic Bronchopulmonary Aspergillosis; Aspergillus; Bronchial Diseases; Lithiasis

MeSH Terms

Lithiasis/*complications/*diagnosis
Humans
Female
Bronchial Diseases/*complications/*diagnosis
Asthma
Aspergillosis, Allergic Bronchopulmonary/*complications/*diagnosis
Adult

Figure

• 

  Fig. 1 (A, B) Posteroanterior and lateral chest radiographs revealed a mass-like segmental consolidation (arrows) in the anterior segment of the right upper lobe. (C) A contrast-enhanced computed tomography (CT) scan (5-mm-collimation) displayed a 12-mm calcified hilar lymph node (arrow), which completely obstructs the lumen of the anterior segmental bronchus of the right upper lobe, with a resultant distal segmental obstructive pneumonia which was suggestive of broncholithiasis. (D) Non-enhanced, high resolution (1-mm-collimation) CT scan obtained at a lower level to C revealed a slightly high-attenuation branching structure (arrows) within the segmental consolidation, which is suggestive of mucoid impaction within the ectatic subsegmental bronchi. Note the small calcified nodule (arrowhead) in the right upper lobe, which suggests a calcified granuloma resulting from an old tuberculous infection, together with several calcified lymph nodes in the right hilar and paratracheal regions (not shown here).

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  Fig. 2 Bronchoscopic biopsy specimen. Photomicrography of the impacted mucoid material revealed parallel rows of necrotic eosinophils and cellular debris, within a mucinous background (H&E, ×100). Inset: Branching fungal hyphae within impacted mucus, suggestive of Aspergillus species (GMS, ×400)

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  Fig. 3 Histologic sections of resected lung specimen. (A) Low-magnification photomicrography showed a dilated bronchus with mucus impaction (H&E, ×1). (B) Peribronchial granulomas with central necrosis (H&E, ×40). (C) Bronchocentric inflammation and granuloma (H&E, ×100). (D) Eosinophilic pneumonia (H&E, ×100).

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