Key result
The authors argue that the previously reported case of ABPA-CPA overlap in an 80-year-old woman was more likely an ABPA exacerbation or concomitant airway invasive aspergillosis.
This letter challenges a previously published diagnosis of ABPA-CPA overlap, suggesting it was likely an ABPA exacerbation and highlighting the superior efficacy of oral over inhaled glucocorticoids.
To the Editor We read the case of overlap between allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA) reported by Ishiguro et al. (1) The authors describe an eighty-year-old lady with ABPA treated with inhaled steroids and two weeks of oral prednisolone.Subsequently, she was treated with oral itraconazole, followed by oral voriconazole for three months.However, the chest radiograph findings had worsened, and the patient was again treated with oral prednisolone, which resulted in improvement.The authors describe the occurrence of nodules (which are mucus-plugged bronchi) that increased in size after treatment with biological agents (benralizumab and dupilumab).Finally, the authors diagnosed her with ABPA-CPA overlap and treated the patient with micafungin and voriconazole, thus resulting in clinical improvement.There are several learning points in the index case.The case highlights the fact that oral glucocorticoids (2) and not inhaled steroids (3) are the most effective treatments, as highlighted by improvement each time the patient received prednisolone.Furthermore, the patient would have benefited from either a longer duration of systemic glucocorticoids or a combination of a shorter duration of steroids followed by prolonged treatment with oral azoles.Second, the authors labeled the case as an ABPA-CPA overlap.We do not agree with this suggestion.A typical case of CPA should have one or more cavities, a fungal ball, pleural thickening, and others on chest imaging, none of which were observed in the reported case.Furthermore, in patients with underlying ABPA, progression to CPA is associated with the development of cavities, fungal balls, fever, chest pain, hemoptysis, and other clinical symptoms.
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Sehgal et al. (2024) conducted a letter in Allergic bronchopulmonary aspergillosis (ABPA) (n=1). Oral glucocorticoids was evaluated. The authors argue that the previously reported case of ABPA-CPA overlap in an 80-year-old woman was more likely an ABPA exacerbation or concomitant airway invasive aspergillosis.
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