Severe Asthma with Fungal Sensitisation

Case number: 

61

Summary: 

A 41-year-old lady is diagnosed with asthma. Four years later her symptoms rapidly worsen after camping outside in a damp tent. Two years following this, her symptoms remain florid giving her the label of severe asthma and requiring almost continuous steroids. A further two years pass and blood tests lead to a diagnosis of presumed ABPA. Short-term treatment with oral itraconazole fails due to the concomitant use of lansoprazole (decreasing the absorption of the antifungal). She remains unwell. A move from the Midlands to the North West precipitates a review of both her symptomatology and her diagnoses. A negative serum Aspergillus precipitins with a total IgE level of 470 KIU/l (Aspergillus fumigatus specific IgE 4.7 KUa/l) suggests a diagnosis of SAFS (Severe Asthma with Fungal Sensitisation) rather than ABPA. A higher dose of oral itraconazole is commenced. Over the subsequent eighteen months her symptoms improve dramatically

Species: 

  • Aspergillus fumigatus