Thread by @ucsdim

Hey #MedTwitter!!
This morning at our VA we had Chief @photon_ick give us a case of #ChronicSOB, where it turned out that the patient had #ABPA (#allergic bronchopulmonary #aspergillosis). It's a diagnosis we don't see too often, but one you'll definitely encounter here!! 🗝️👇

This is an #allergic condition, with 2 main predisposing conditions: #asthma & #cysticfibrosis
It can be more rarely seen in other lung disease/immunodeficiencies, but without the right lung environment like this, it is almost NEVER seen!!

There is no universally accepted criteria, but the #ISHAM criteria is often used. Let's check it out!

Traditional obligatory criteria:
- Serum #IgE RAST >0.35 OR Allergic Skin Testing (+) to A. fumigatus
- Total Serum IgE >1000

In addition to the obligatory stuff, there are additional criteria as well (need ≥ 2)
- Total Serum #Eos > 500 cell/uL
- Imaging c/w #ABPA (like these!)
- Serum #IgG (not E) RAST to A. fumigatus > 27 (much higher than the IgE threshold!)

Once you're sure it's ABPA, the treatment is #steroids for the inflammation, & #antifungals (#itraconazole or #voriconazole) to try to rid any of the aspergillus from the system.

LONG courses (months) are required for both of these therapies, but remission is possible!!

@LukewebsterMd @daniellemunceMD @DirkGainesMD @AlexCypro @ucsdpccm @SimerjotJ
#InternalMedicine #MedEd #MedStudentTwitter #Pulmonary #Pulm #PCCM #InfectiousDisease