Allergic broncho pulmonary aspergillosis associated with eosinophilic gastro enteritis – a case report

Author:

Ghiordanescu, IM 1; Balea, MI 2; Bumbacea, RS 3; Bumbacea, D 4

Author address:

1 Life Med Clinic, Allergology, Bucharest, Romania; 2 Colentina Clinical Hospital, Pneumology, Bucharest, Romania; 3 Dermatology and Allergology, Elias Emergency University Hospital, Bucharest, Romania; 4 Pneumology, Elias Emergency University Hospital, Bucharest, Romania

Full conference title:

European Academy of Allergy and Clinical Immunology Congress 2015

Date: 5 August 2020

Abstract:

Background: Allergic Broncho Pulmonary Aspergillosis (ABPA) is a rare disease that may be associated with marked peripheral blood eosinophilia, but eosinophilic infiltration of organs other than the lungs is unusual.

Method: We present a case of ABPA associated with Eosinophilic GastroEnteritis (EGE) that raised differential diagnosis issues. A 66 years old female was admitted to our service with breathlessness, wheezing, a history of 2 months of recurrent fever and weight loss. She associated nonbloody diarrhoea and a 9 years history of chronic rhinosinusitis, asthma and persistent hypereosinophilia. Based on paraclinical data we have classified the case as an allergic bronchopulmonary aspergillosis gathering 6 out of 8 major classic criteria: asthma, central bronchiectasis, peripheral blood eosinophilia, increased total serum IgE, serum precipitating antibodies and specific A. fumigatus serum IgE; this case also fulfills recently proposed criteria for ABPA diagnosis. In our case ABPA was associated with biopsy – proven eosinophilic gastroenteritis. Treatment with methylprednisolone resulted in significant clinical improvement.

Results: To our best knowledge, the association of eosinophilic gastroenteritis to ABPA has not been previously described. The presence of marked peripheral blood eosinophilia together with eosinophilic gastrointestinal infiltration raises significant differential diagnosis with hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA). The role of Aspergillus (and in general of aeroallergens) in the pathogenesis of eosinophilic gastroenteritis is supported by several lines of evidence. In fact both HES and EGPA are rendered less likely by the immunologic evidence of Aspergillus-related disease (specific IgE and precipitins). Aspergillus-induced Th2 response might be responsible for eosinophilic infiltration of gastrointestinal wall, which might be the case also in our patient. Although swallowed aeroallergens might be the mechanism of EGE, the existence of peripheral blood Aspergillus-specific T-cells and the co-existence of respiratory disease suggest a systemic pathogenesis with involvement of homing receptors in gastrointestinal mucosa.

Conclusion: We describe the first case of allergic bronchopulmonary aspergillosis associated with eosinophilic gastroenteritis, and we hypothesize that Aspergillus-related Th2 response is responsible for both diseases.

Abstract Number: 1253

Link to conference website:

Link Conference abstract: 

EAACI 2015

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