An unusual presentation of pulmonary mass like lesions secondary to an allergic cause

Background:31yr old male referred for evaluation of pulmonary masses presents with symptoms of cough with expectoration for 3yrs,intermittent dyspnoea & hemoptysis.H/o use of frequent antibiotics.loss of appetite& weight present MethodsCXR show perihilar & central pulmonary masses.CT sugg of large nodular bilateral opacities in upper lobes,middle lobe,lingula close to hilum,few small nodules in both lower lobes with no adenopathy. Bronchoscopy (FOB) showed features of dilatation of Rt Upper lobe,Middle lobe bronchi with extrusion of impacted mucus balls sugg of Bronchiectasis with inspissated mucus with no endobronchial growth ResultsBroncho alveolar lavage & washings grew pseudomonas & aspergillus fumigatus,negative for malignancy and negativeAFB smear & cultures,Total IgE70 IU/ml,Absolute eosinophil count 200,Mantoux negative,allergy Skin tests positive for A.fumigatus,High A.fumigatus Ab 2560,Specific IgE m3asp39,50 Kua/L.Pulmonary function showed moderate obstruction with significant reversibility sugg of asthma. Treated with Levofloxacin 2wk, Oral steroids 0.5mg/kg 2mth with tapering doses.Formeterol & Budesonide inhaler 160mcg 2puffs BD with Chest physiotherapy .His CXR& CTscan showed complete clearance of pulmonary nodular masses in 2mths timeConclusion An Unsual presentation of Allergic Bronchopulmonary aspergillosis ABPA, which mimic tumour like opacities due to Mucus plugging ,revealing underlying central bronchiectasis after clearance of mucus balls with background of undiagnosed asthma Reference Allergic bronchopulmonary aspergillosis.Patterson StrekME Dept of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL 60637, USA: 2010 May;7(3):237-44 Proc American Thoracic Society