CRA11 ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS IN NONCLASSIC CYSTIC FIBROSIS: AN UNCOMMON CAUSE OF DIFFICULT-TO-TREAT ASTHMA IN AN ASIAN ADULT

Authors:
Leng Cheng Sia1, Andrew Yeoh1, Chun Ian Soo1
1Department of Medicine, University Malaya Medical Centre, Kuala Lumpur (Malaysia).

Introduction

Allergic bronchopulmonary aspergillosis (ABPA) typically occurs in patients with underlying asthma or cystic fibrosis, with about 10% of Cystic fibrosis patients having ABPA as a comorbidity. CF is an autosomal recessive disorder that commonly affects Caucasian population. Nonclassic CF with isolated organ involvement accounts for only 2%. 

Objectives 

Herein, we present a case of ABPA in nonclassic CF patient in an Asian lady.

Methodology 

A 58-year-old Indian lady presented with a chronic productive cough and wheezing since the age of 20. She was also diagnosed with adult-onset asthma, chronic rhinosinusitis with nasal polyps. Clinical examination revealed bilateral rhonchi and coarse crepitation, predominantly in the upper zones. Her mother had also been diagnosed with adult-onset asthma.

Results 

Her asthma became poor controlled at the age of 50 with an Asthma Control Test score of 7-10 despite being on nasal steroid spray, montelukast, high dose inhaled corticosteroid, and long acting beta-agonist bronchodilator. She had 2-3 exacerbation yearly. Her serum IgE of 21600 IU/mL  ; serum IgE specific to Aspergillus Fumigatus of 37.2 kUA/L, and her serum eosinophils reached 2,540 cells/μL at its highest. skin prick tests to Aspergillus Fumigatus and serum precipitins were both negative. High resolution computed tomography demonstrated diffuse bronchiectasis with an upper zone predominant. Her sweat test was positive at 72 mmol/L. CF had not been suspected previously because the onset and symptoms of disease were similar to asthma and CF is not common in this region. Our case highlight that skin prick test and serum precipitin are less sensitive compared to serum specific IgE to Aspergillus fumigatus. 

Conclusion

All patients with difficult -to-treat-asthma warrant screening for Aspergillus sensitisation. A sweat test should be performed in all adult patients with bilateral idiopathic bronchiectasis.