Aspergilosis broncopulmonar alérgica. Complicaciones poco usuales de la afección

Abstract

Definition, etiology, clinical stages, treatment and complications of Allergic Bronchopulmonary Aspergillosis (ABPA) are reviewed. Thirty five cases of ABPA have been followed during an average of 15 years at Instituto Nacional del Tórax-Chile. From this series two female patients, corresponding to ABPA complicated by Mycobacterium avium-intracellulare (MAI) infection are presented. The patients that were 71 and 72 years old respectively, presented a MAI pulmonary infection 3 and ten years after being diagnosed them ABPA. Their clinical and radiological characteristics, as well as their immunological tests (skin test, Elisa IgG + for A. fumigatus) gave ground for ABPA diagnosis. In both cases MAI pulmonary infection -confirmed by two positive cultures of MAI- was associated to clinical and radiological worsening. Patients were succesfully treated with claritromycin and ethambutol during 12 months; this treatment was associated to streptomycin and minocycline for the first two months. MAI infection is a rare ABPA´s complication. This association should be suspected if a high resolution CT scan shows nodules associated to diffuse bronchiectasis located beyond the central bronchiectasis (typical lesion in non-complicated ABPA). MAI pulmonary infection should be confirmed by MAI cultures in sputum or in bronchoalveolar lavage fluid