Case of allergic bronchopulmonary aspergillosis secondary to cocaine use and tuberculosis.
This article describes the case of a 57-year-old male patient with allergic bronchopulmonary aspergillosis (ABPA) with a history of chronic cocaine use and tuberculosis. He presented to the emergency with a 3-month history of progressively worsening dyspnea. Physical examination showed diffuse wheezing. He complained of 20 pounds of weight loss over the last three decades and increased urinary retention. He didn’t have a recent travel history, nor did he smoke. In addition, he denied fevers, chills or hemptysis.
Investigations and findings
Doctors advised labs including acid fast-bacilli smear, myobacterium polymerase chain reaction, Legionella antigen, and neutrophilic cytoplasmic antibody were all negative. However, the patient’s urine drug test was positive for cocaine. Moreover, his IgE levels came back elevated, based on which doctors advised gE against Aspergillus fumigatus which came back positive.
Chest X-ray showed pleural thickening, flattened diaphragm and hyperinflation. Chest CT showed bilateral bronchial wall thickening and bronchiectasis in the lower lobes. There were signs of bronchial wall thickening, bronchiectasis and tree-in bud nodularity in the right upper lobe. In addition, a solid nodule was present in the posterior medial right lung. The mass was also visible in a 3-month old CT scan. It had been grossly stable since then, measuring 1.0 × 2.2 × 1.8 cm.
Treatment
The patient was initially treated with amoxicillin-clavulanate and a 7-day course of prednisone 10 mg which resulted in transient improvement. Doctors advised treatment with 60 mg intravenous methylprednisolone BID and inhaled ipratropium bromide with albuterol sulfate before confirmation of acute bronchopulmonary aspergillosis. Once diagnosed, he was treated with a 4-day treatment course with 60 mg oral prednisone. He showed significant improvement in symptoms at the time of discharge.
References
A Case of Allergic Bronchopulmonary Aspergillosis (ABPA) in a Patient with a History of Cocaine Use and Tuberculosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6907060/
