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 Image
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!) ImageImage
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!!

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More from @ucsdim

Jan 5, 2021
Our #residents got to learn about #syncope & #adrenalinsufficiency today from Rising Chief @LizzyHastie, Chief @photon_ick, & Endo-enthusiast @tsantoscavaiola!!

Check out some highlights below we wanted to make sure we shared with our #MedEd peeps on #MedTwitter!! Image
Don’t forget about adrenal insufficiency!! For patients with things like #syncope or #hypotension, it’s easy to forget about cortisol as a cause! While things like dehydration, infection, & other things may be more common overall… AI is #treatable, so make sure you catch it!!
Primary AI = #adrenal glands themselves are the problem. This means #cortisol AND #aldosterone will be low, while #ACTH AND #Renin will be very elevated in attempt to remedy this! Image
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