2022 Volume 44 Issue 3 Pages 188-192
Background. The Japan Allergic Bronchopulmonary Mycosis (ABPM) Research Program has proposed new clinical diagnostic criteria for ABPM in 2019. These criteria have made it possible to widen the range of symptoms when making an ABPM diagnosis. Case. A 43-year-old woman with no history of bronchial asthma was referred to our hospital due to a cough lasting for a month. Chest computed tomography (CT) revealed a mucous plug with central bronchiectasis in the right B4 and infiltrative shadows and centrilobular nodules in the peripheral right S4. The serum IgE levels and peripheral blood eosinophil counts were within the normal ranges. The mucous plug obstructing the right B4 was bronchoscopically identified and removed. A microscopic examination of the mucous plug showed marked eosinophil infiltration with hyphae. A culture revealed the presence of Schizophyllum commune. The serum levels of both anti-S. commune IgG and IgE were elevated. Thereafter, the patient's symptoms diminished, and the abnormal shadows on chest CT improved. No recurrence has been observed for five years. The patient was therefore retroactively diagnosed with ABPM according to the new criteria. Conclusion. Even if patients have no symptoms of bronchial asthma, those presenting with mucus plugs in the central bronchi should be suspected of having ABPM and therefore should undergo bronchoscopy.
