Vol. 2, Issue 1, Part A (2020)

Allergic bronchopulmonary aspergillosis (ABPA) in a patient without previously diagnosed asthma or cystic fibrosis with pleural effusion at presentation is uncommon and rare. In a high tuberculosis burden country like India, patients with pleural effusion are frequently misdiagnosed as tuberculosis even when there is no bacteriological confirmation. We report a case of a 48-year female who presented with left side pleural effusion not resolving on antitubercular treatment from two months. The pleural fluid was exudative with 20% eosinophils. Investigations revealed peripheral eosinophilia with HRCT thorax showing left lingular and right upper lobe bronchiectasis. Spirometry showed reversible moderate obstruction. Elevated serum immunoglobulin E, Precipitating serum antibodies to Aspergillus fumigatus were positive and the Aspergillus fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with eosinophilic pleural effusions was made and the patient was commenced on prednisolone. At review, the patient’s symptoms had considerably improved and her pleural effusions had resolved.