Life-threatening allergic bronchopulmonary aspergillosis in a well child with cystic fibrosis

Emma Skowronski and Dominic A Fitzgerald
Med J Aust 2005; 182 (9): 482-483.

Allergic bronchopulmonary aspergillosis (ABPA) is an uncommon condition which may complicate asthma and cystic fibrosis; it is seldom considered life-threatening. We report a well 8-year-old boy with cystic fibrosis and normal lung function who progressed to respiratory failure over several days, attributable to ABPA. He recovered with non-invasive ventilation and oral corticosteroid and antifungal medications, regaining normal lung function within 2 months. To our knowledge, such an acute severe presentation of ABPA in a previously well child has not been reported before.

Clinical record

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  • Emma Skowronski1
  • Dominic A Fitzgerald2

  • 1 University of Sydney, Sydney, NSW.
  • 2 Children’s Hospital at Westmead, Sydney, NSW.



We thank Dr Jonathan Gillis and the intensive care specialists, and Associate Professor Albert Lam for his assistance in providing the chest radiographs for presentation.

  • 1. Mastella G, Rainisio M, Harms HK, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis. A European epidemiologic study. Eur Respir J 2000; 16: 464-471.
  • 2. Mroueh S, Spock A. Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. Chest 1994; 105: 32-36.
  • 3. Proceedings of the Cystic Fibrosis Foundation ABPA consensus conference. Bethesda, Md: 2001 Jun 12–13. Bethesda, Md: North American Cystic Fibrosis Foundation, 2002.
  • 4. Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol 2002; 110: 685-692.
  • 5. Varkey B. Allergic bronchopulmonary aspergillosis: clinical perspectives. Immunol Allergy Clin North Am 1998; 18: 479-501.
  • 6. Stevens DA, Schwartz HJ, Lee JY, et al. A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis. N Engl J Med 2000; 342: 756-762.
  • 7. Vaughan LM. Allergic bronchopulmonary aspergillosis. Clin Pharm 1993; 12: 24-33.
  • 8. Fitzgerald DA, Cooper DM, Paul M, et al. Burkholderia cepacia in cystic fibrosis: novel Australian cluster strain without accelerated respiratory deterioration. J Paediatr Child Health 2001; 37: 130-136.
  • 9. Lee TM, Greenberger PA, Patterson R, et al. Stage V [fibrotic] allergic bronchopulmonary aspergillosis. A review of 17 cases followed from diagnosis. Arch Intern Med 1987; 147: 319-323.
  • 10. Knutsen AP, Bellone C, Kauffman H. Immunopathogenesis of allergic bronchopulmonary aspergillosis. J Cystic Fibrosis 2002; 2: 76-89.
  • 11. Klein NC, Cunha BA. New antifungal drugs for pulmonary mycoses. Chest 1996; 110: 525-532.
  • 12. Nepomuceno IB, Esrig S, Moss RB. Allergic bronchopulmonary aspergillosis in cystic fibrosis: role of atopy and response to itraconazole. Chest 1999; 115: 364-370.
  • 13. Wark PAB, Hensley MJ, Saltos N, et al. Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis: a randomized controlled trial. J Allergy Clin Immunol 2003; 111: 952-957.
  • 14. Skov M, Main KM, Sillesen IB, et al. Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide. Eur Respir J 2002; 20: 127-133.


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