A CASE OF ALLERGIC BRONCHOPULMONARY MYCOSIS DUE TO CRYPTOCOCCUS

Abstract

An 18-year-old man was admitted to the hospital because he had a high fever and a severe cough with hemoptysis. A chest X-ray examination demonstrated a fluid-filled cyst measuring 4×4cm in the middle field of the right lung. He was allergic to house dust, ticks, and several kinds of foods and plants. He had been suffering from chronic rhinorrhitis for a long time, but he did not have asthma. After administration of CLDM (1.2g/day) and CTM (2.0g/day) for eight days, the infection of the cyst subsided, but the cyst itself remained as it had been. A few weeks after he was discharged from our hospital, he had a second infection of the cyst. During the second hospitalization, a diagnosis of infected bronchogenic cyst was made and surgery was eventually indicated. A partial resection of the right lung, including the cyst, was performed under thoracoscopic control. As a result of the resection, an actual pathological diagnosis was made to be allergic bronchopulmonary mycosis (ABPM) with cryptococcus instead. Histology revealed bronchocentric granulomatosis with epitheloid granuloma and necrotic eosinophils. We had been unable to accurately diagnose the ABPM before surgery because the symptoms and findings obtained by diagnostic examinations had not fulfilled Rosenberg's criteria. However, the findings obtained by histological and immunological examinations of resected specimen were consistent with the Bosken's criteria of ABPM.