A 50-year-old woman with a 20 pack-year smoking history presents with chronic cough, wheezing, and expectoration of brownish mucus plugs. Total IgE is 2500 IU/mL, Aspergillus-specific IgE is elevated, and chest X-ray shows central bronchiectasis with 'gloved finger' opacities. What is the diagnosis?
- A Allergic bronchopulmonary aspergillosis ✓
- B Tuberculosis
- C Eosinophilic granulomatosis with polyangiitis
- D Hypersensitivity pneumonitis
Correct answer: A. Allergic bronchopulmonary aspergillosis
Explanation
ABPA is a hypersensitivity reaction to Aspergillus colonizing airways, typically in asthma or cystic fibrosis. Diagnostic features include elevated total IgE (>1000 IU/mL), Aspergillus-specific IgE, central bronchiectasis, and mucoid impaction causing 'gloved finger' or 'toothpaste' shadows. EGPA has peripheral eosinophilia and systemic vasculitis features.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.