While I started my consultancy at Hill Park general Hospital. Once an old man brought his young 25 year old daughter in my OPD with the complaints of breathlessness off and on since long and history of recent hemoptysis, cough and fever. On general examination I found a sick looking girl who was febrile and had prolonged expirations and scattered wheezes on chest auscultation. She had profound clubbing of all her fingers. She had a pile of investigations in her file with many prescriptions with advised salbutamol inhaler, with no benefit. She was not diagnosed of asthma yet!
I ordered a chest X-ray which revealed bilateral pulmonary infiltrates. Later I advised CT scan chest which revealed central bronchiectasis with multiple bilateral infiltrates. Her CP showed high eosinophil count so I checked for antibodies to aspergillus fumigatus. Her serum IgE was also very high 1000 IU/L.
So the diagnosis of Allergic alveolar bronchopulmonary aspergillosis (ABPA) was made. I started her with systemic corticosteroids (0.5 mg/kg) orally for two weeks. She got much better. Then I reduced the dose and slowly tapered over 3 months. I also gave her itraconazole 200 mg thrice a day for three days, followed by twice daily for 4 months. I continued with bronchodilators. Lesson to take home is, never ignore any asthmatic patient who is febrile and having hemoptysis and who is not improving with bronchodilators and antibiotics. Always think of conditions that can complicate asthma like ABPA. Most commonly, even asthma might have not been diagnosed yet as the patient might not give any history of asthma, as in this case!
Dr. Zeba Hisam