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1/20. Allergic bronchopulmonary aspergillosis with obstruction of the upper respiratory tract.

    A case of allergic bronchopulmonary aspergillosis is presented. The only symptoms in this 24-year-old woman patient were those of recurrent nasal obstruction, including mucosal ulcerations, edema, and thick secretions within the nose.
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2/20. Allergic granulomatous angiitis (churg-strauss syndrome) associated with allergic bronchopulmonary candidiasis.

    We describe a case of churg-strauss syndrome (CSS) associated with allergic bronchopulmonary candidiasis (ABPC). A 61-year-old man who had been given a diagnosis of ABPC based on serologic and radiographic findings experienced pain and purpuric rash on the left leg accompanied with motor weakness. The diagnosis of CSS was made from skin, nerve and muscle biopsies. Although immunosuppressant and prednisolone were administered and resulted in transient improvement, candidal pneumonia was suspected to have developed 60 days after the administration and the patient finally died of respiratory failure. To our knowledge, this is the first case of CSS associated with ABPC.
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3/20. Allergic bronchopulmonary disease caused by Bipolaris hawaiiensis presenting as a necrotizing pneumonia: case report and review of literature.

    We report a case of allergic bronchopulmonary disease caused by Bipolaris hawaiisensis in an immunocompetent host, presenting with symptoms and radiographic findings suggestive of necrotizing pneumonia. Cultures of the plugs and bronchial washing yielded the pathogenic fungi. Laboratory tests revealed eosinophilia and elevation of serum IgE. This patient was successfully treated with steroids, amphotericin b lipid complex, and itraconazole. review of 10 previously reported cases and their clinical manifestations and treatment are presented.
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4/20. Sinobronchial allergic mycosis: the SAM syndrome.

    We contend that the presence of concomitant allergic fungal sinusitis (AFS) and allergic bronchopulmonary mycosis in the same patient represents an expression of the same process of fungal hypersensitivity in the upper and lower airways. We have termed this process the SAM syndrome, an acronym for sinobronchial allergic mycosis. Diagnostic criteria have been established for the SAM syndrome, and the clinical characteristics of one previously unreported and four previously reported patients have been tabulated. patients with the SAM syndrome have chronic sinusitis involving multiple sinuses, asthma, immediate cutaneous reactivity to fungal allergens, peripheral eosinophilia, and radiographic evidence of bronchiectasis. Total serum IgE levels are usually elevated as well. A variety of chest radiographic abnormalities may occur, ranging from mass lesions to diffuse pulmonary infiltrates and even normal findings on chest radiographs. patients present for an evaluation of either sinus or lung disease and, at that time, demonstrate no clinical features that distinguish them from patients with isolated sinus or lung disease. All patients reported to date have had clinical responses to therapy with corticosteroids. We postulate that SAM is underdiagnosed in patients with AFS, a disease recently reported from medical centers in the southeastern and western united states. Moreover, since our patient had a mutation in the cystic fibrosis transmembrane conductor regulator (CFTR) gene, we further hypothesize that CFTR gene mutations may play an important role in the pathogenesis of the SAM syndrome.
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keywords = bronchopulmonary
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5/20. hypersensitivity pneumonitis after exposure to isocyanates.

    Four patients exposed to isocyanate vapour developed dyspnoea associated with restriction and reduced gas transfer as well as moderate airways obstruction on lung function testing. In one patient bilateral radiographic shadowing was present and an open lung biopsy was performed. The microscopic appearances ranged from acute inflammation to end-stage fibrosis but the centribular accentuation of disease and the presence of areas resembling bronchopulmonary aspergillosis suggested that the process was a hypersensitivity response to inhaled allergen. Challenge tests with albumin and toluene diisocyanate-albumin were carried out in sensitized and control rabbits. The sensitized animals developed extensive lung damage of the type associated with an arthus reaction. It is suggested that patients exposed to isocyanates may occasionally develop a hypersensitivity pneumonitis rather than the more usual asthmatic syndrome.
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keywords = bronchopulmonary
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6/20. Fibrotic stage of allergic bronchopulmonary candidiasis.

    Since its first description in 1952, ABPA has been recognized with increasing frequency. More recently fungi other than aspergillus fumigatus, in particular candida albicans, have been implicated in a similar disease process. The following case report illustrates the possibility of finding a fibrotic stage 5 ABPM caused by C albicans.
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keywords = bronchopulmonary
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7/20. Rose hips: a new occupational allergen.

    We evaluated 13 workers with respiratory symptoms apparently related to occupational exposure to powdered rose hips. Nine workers had asthma, five had rhinitis, and one worker had urticaria. Seven workers had evidence of IgE specific for rose hips based on positive skin prick tests and positive in vitro tests. Four workers with histories suggestive of asthma related to work exposure underwent bronchopulmonary challenges with rose hips, and two workers had positive challenges with greater than 20% declines in FEV1 measurements. We conclude that rose hips are occupational allergens capable of producing asthma.
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keywords = bronchopulmonary
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8/20. Bronchocentric granulomatosis: a complication of allergic bronchopulmonary aspergillosis.

    hypersensitivity to the fungal antigens of aspergillus fumigatus may result in a spectrum of immune injury collectively known as allergic bronchopulmonary aspergillosis (ABPA). This report describes a 14-yr-old boy who presented clinical findings consistent with ABPA,including a history of asthma, blood eosinophilia, serum precipitins, and IgE antibodies to aspergillus fumigatus. sputum Aspergillus, pulmonary infiltrates, and dual types I and III skin reactions to aspergillus fumigatus were observed also. pathology of the resected right upper lobe revealed severe bronchial destruction with the findings of bronchocentric granulomatosis. Noninvasive septate fungal hyphae compatible with Aspergillus were identified. Cultures from sputum and surgical specimens grew Aspergillus and mycobacterium intracellulare avium. The PPD-B (purified protein derivative-Batty) intradermal skin test produced a 6 mm induration (PPD-S was negative). The patient's condition has been well controlled with prednisone and several antituberculous drugs. In addition, inflammatory and immunologic parameters have begun to return to normal. The relationship between ABa and the atypical mycobacterial infection is not clear. The association of ABPA with the severe bronchial destruction seen in bronchocentric granulomatosis is emphasized to alert physicans to this serious sequelae of ABa seen in the asthmatic.
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keywords = bronchopulmonary
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9/20. Allergic bronchopulmonary candidiasis: case report and suggested diagnostic criteria.

    A patient with an illness consistent with allergic bronchopulmonary candidiasis is described. The patient had asthma, atelectatic pulmonary infiltrates on three occasions, immediate cutaneous reactivity as low as 10(-7) (wt/vol) to candida albicans extract, and precipitating antibody to this organism. C. albicans was the only organism cultured from two bronchial lavage specimens. Total serum IgE was elevated to 5745 ng/ml and decreased rapidly with corticosteroid therapy. Serologic studies were not consistent with allergic bronchopulmonary aspergillosis. serum IgE to C. albicans, measured by ELISA after adsorption of IgG from the serum samples by incubation with staphylococcal protein a, was found to be 575% to 650% above control values. The serum IgE antibody activity against Candida decreased with clinical improvement after corticosteroid therapy.
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keywords = bronchopulmonary
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10/20. Allergic bronchopulmonary curvulariosis.

    A patient with clinical and roentgenographic findings suggestive of allergic bronchopulmonary disease who presented with recurrent pulmonary infiltrates with peripheral eosinophilia was identified. sputum cultures were positive for Curvularia lunata. Total serum IgE was elevated, and intracutaneous skin testing with C. lunata was positive. serum precipitins against C. lunata were present with specific IgE and IgG antibody indexes elevated. These studies provide further Immunologic characterization of this uncommon disorder.
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keywords = bronchopulmonary
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