A 35-year-old man with longstanding asthma presents with recurrent brownish mucus plugs, fever, and fleeting pulmonary infiltrates. Total serum IgE is 2500 IU/mL. Chest imaging shows central bronchiectasis. Which finding is the most specific diagnostic criterion for Allergic Bronchopulmonary Aspergillosis (ABPA)?

• A Total serum IgE greater than 1000 IU/mL
• B Positive immediate cutaneous hypersensitivity to Aspergillus
• C Peripheral blood eosinophilia greater than 1000 per microliter
• D Central bronchiectasis with high-attenuation mucus on imaging ✓

Explanation

Central bronchiectasis with high-attenuation mucus is the most specific finding for ABPA and is part of the major diagnostic criteria. Elevated total IgE and eosinophilia are supportive but nonspecific. Positive skin test indicates Aspergillus sensitization, which is common in asthma without ABPA.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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