D1.478 - Hyper-IgE in allergic bronchopulmonary aspergillosis: diagnostic challenges

Allergic bronchopulmonary aspergillosis (ABPA) is a condition that affects patients with asthma in 1–3.5% of cases and 2–15% of patients with cystic fibrosis. It is characterized by elevated serum levels of IgE and IgG antibodies against Aspergillus fumigatus (Af), determined using the fluoroenzyme immunoassay method. Elevated total IgE levels represent a defining feature of ABPA and remain essential for the diagnosis, classification, and monitoring of this condition. High IgE levels have not only diagnostic value but may also carry prognostic significance, being associated with rapid disease progression, an increased risk of exacerbations, and progression of structural pulmonary damage.

The patient’s clinical data, medical history, laboratory investigation results, and imaging findings (pulmonary CT) of a child hospitalized at the Mother and Child Institute are presented.

A 16-year-old female patient was admitted to the Pulmonology Department of the Mother and Child Institute with complaints of productive cough with mucopurulent sputum, periodically accompanied by hemoptysis.She was diagnosed with cystic fibrosis (CF) at the age of 3 years (CFTR F508del/F508del). Investigations revealed elevated total IgE levels (>562.2 IU/mL), positive specific IgE to Aspergillus fumigatus (2.29 AU/mL), and positive anti-A. fumigatus IgG. Pulmonary CT showed cylindrical and varicose bronchiectasis in segments S2, S4, and S5; on the left side, cylindrical, varicose, and saccular bronchiectasis distributed in the projection of segments S1/2, S3, S4–S6, and S8, with mucus within the lumen, as well as fibroatelectatic areas in segments S4 and S5. Microbiological examination of sputum in 2025 confirmed the presence of mold fungi. Based on clinical, imaging, and immunological criteria, a diagnosis of ABPA was established. The patient was treated with systemic corticosteroids, antifungal agents, antibiotics, hemostatic therapy, nebulized Pulmozyme, and courses of tobramycin. Over time, respiratory symptoms improved and total IgE levels decreased to 161.2 IU/mL. 

Elevated serum IgE levels are significant for establishing an accurate diagnosis of ABPA and for identifying the risk of exacerbations. A personalized therapeutic approach, combining corticosteroid therapy, antifungal agents, and cystic fibrosis–specific symptomatic treatment, is essential to prevent disease progression and deterioration of pulmonary function.