A case of allergic bronchopulmonary aspergillosis in a patient with a history of pulmonary tuberculosis and chronic obstructive pulmonary disease (COPD)

Allergic bronchopulmonary aspergillosis (ABPA) is an inflammatory disease that is usually seen in patients with uncontrolled asthma, who have allergic sensitization to Aspergillus antigen. However, patients without asthma may rarely develop ABPA. We present a case of a patient who was hospitalized due to chronic obstructive pulmonary disease (COPD) exacerbation and was referred to the allergy clinic due to elevated total Immunoglobulin E (IgE), leading to a diagnosis of ABPA. The patient, previously treated for pulmonary tuberculosis, had COPD and a total IgE value over 2,500 IU/mL. Aspergillus-specific IgE was positive. While receiving systemic steroid therapy, the patient's blood eosinophil count was 190 cells/mu L, and the pulmonary function test showed an obstructive pattern. Radiological imaging revealed emphysema, parenchymal distortion, bronchial enlargement, and cavitation. These findings led to a diagnosis of ABPA. ABPA may develop in patients with post-tuberculosis structural lung disease or COPD who have Aspergillus sensitization. Therefore, if these patients exhibit clinical and radiological findings compatible with ABPA, an investigation for ABPA should be conducted.