Background:
Allergic bronchopulmonary aspergillosis (ABPA) is a disorder caused by hypersensitivity to Aspergillus antigens. The estimated prevalence of ABPA is about 1% to 2% in patients with bronchial asthma and 2% to 15% in patients with cystic fibrosis. Patients with ABPA can have diverse radiological manifestations; however ABPA presenting as a lung masses is a rare presentation. So far, to our knowledge only 10 cases have been reported in literature. Here we report 6 patients of ABPA who presented with lung mass leading to lung cancer as a differential diagnosis.

Objective:
To study the clinical, radiological characteristics and outcome of patients of ABPA presented with a lung mass mimicking lung cancer.

Methods:
Medical records of 6 patients of ABPA presenting with lung mass at Aga Khan University hospital (AKUH), Karachi-Pakistan were reviewed. Diagnosis of ABPA in all cases was made using the Rosenberg criteria. Complete resolution of mass after steroid therapy was also used as an adjunct to diagnosis.

Results:
Of the six patients, five were males with ages of 23 , 26, 30, 46 and 48 years and one female of 32 years. Four patients had a history of mild asthma while 2 patients had a history of only mild allergic rhinitis. The major symptoms at presentation were cough and pleuritic chest pain for 1-2 weeks duration. On chest X-ray four patients had mass like lesion in right upper lobe while in 2 patients the lesions were in left upper lobe. Two patients underwent bronchoscopy and one had CT guided biopsy with non-conclusive results. The diagnosis of ABPA was made on the Rosenberg criteria for the diagnosis of ABPA. In all patients’ serum IgE level was > 2000 IU/ml and 4 had peripheral eosinophilia. In all patients the lung masses completely resolved with steroids therapy (fig 1 and 1A of patient 1) . Before ABPA diagnosis, one patient had already undergone right upper lobectomy on suspicion of malignancy.

Conclusion:
ABPA can present as pulmonary mass lesions and must be considered in the differential diagnosis of mass like lesions in lung, particularly in a patient with a history of asthma. Good clinical history, peripheral eosinophilia and raised IgE levels can help in narrowing the differential diagnosis. Treatment with glucocorticoids is associated with excellent outcomes.


1 / Allergic bronchopulmonary aspergillosis presenting with lung mass-Report of six cases