Severe asthma, ABPA leading to bronchiectasis and CCPA, on voriconazole

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A 57 year old lady with lifelong asthma developed allergic bronchopulmonary aspergillosis (ABPA) about 40 years ago. She is a severe asthmatic, requiring continuous oral steroids. She has developed marked bronchiectasis with pseudomonas colonisation of the airways and latterly cavities in both lung apices, consistent with chronic cavitary pulmonary aspergillosis. She was treated with itraconazole without much benefit, and then developed ankle swelling. She was subsequently treated with voriconazole with marked benefit. Keywords: ABPA, asthma, CCPA, voriconazole