A 32-year-old asthmatic man has increasingly steroid-refractory symptoms with expectoration of brownish plugs. Chest radiograph shows gloved-finger shadows and central (proximal) bronchiectasis in the upper lobes. Total serum IgE is 2400 IU/mL and Aspergillus fumigatus specific IgE is positive. What is the most appropriate additional treatment to add to inhaled therapy?
- A Itraconazole ✓
- B Omalizumab
- C Voriconazole
- D Ethambutol plus rifampicin
Correct answer: A. Itraconazole
Explanation
Allergic bronchopulmonary aspergillosis complicates asthma or cystic fibrosis. Diagnostic essentials include a total IgE above approximately 1000 IU/mL, positive Aspergillus-specific IgE or skin test, central bronchiectasis, and high-attenuation mucus plugging. Treatment is oral corticosteroids with itraconazole, which reduces fungal burden and allows steroid sparing. Voriconazole is reserved for invasive aspergillosis in the immunocompromised host, omalizumab is not standard therapy here, and antitubercular drugs have no role.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.