A 32-year-old asthmatic man has worsening cough with brownish sputum plugs and fleeting infiltrates on serial CXRs. Total IgE is 1400 IU/mL, specific IgE to Aspergillus fumigatus is positive, and HRCT shows central/proximal varicose bronchiectasis with high-attenuation mucus plugging. Which drug provides steroid-sparing benefit when added to oral corticosteroids?
- A Voriconazole
- B Amphotericin B deoxycholate
- C Itraconazole ✓
- D Fluconazole
Correct answer: C. Itraconazole
Explanation
Allergic bronchopulmonary aspergillosis requires total IgE above 1000 IU/mL, Aspergillus sensitization, central bronchiectasis and high-attenuation mucus. Oral corticosteroids are mainstay, and itraconazole added for relapsing or steroid-dependent disease permits dose reduction and improves outcomes. Fluconazole has no activity against Aspergillus, amphotericin is too toxic for this allergic condition, and voriconazole treats invasive aspergillosis rather than ABPA.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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