ABPA with disseminated aspergillosis

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A 60 year-old male presented with one month history of fever, which was associated with cough and expectoration, shortness of breath for the previous 5 days. He was a known asthmatic for past 9 years for which he was receiving combination of inhaled salmeterol, fluticasone and oral salbutamol. He also took Ayurvedic medication. Subsequently, he was diagnosed to have developed allergic bronchopulmonary aspergillosis (ABPA) on the basis of a positive skin test, presence of central bronchiectasis and elevated levels of specific serum IgE. He was treated with oral steroids for 6 months, which were tapered off in view of symptomatic improvement. The fever recurred after one year but subsequently he deteriorated. A culture of bronchoalveolar lavage fluid revealed growth of Aspergillus fumigatus. Chest X-rays, CECT and HRCT showed bilateral upper zone and midzone consolidation and bilateral pleural effusion, both lower lobes showed bronchiectasis, progression of the lesions was seen. The patient's condition progressively deteriorated during his hospital stay and he succumbed to his illness following a cardiorespiratory arrest.

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