Correct!
5. All of the above are possible causes of bronchiectasis
Originally described by Laennec in 1819, bronchiectasis is a chronic damage to the airway usually caused by suppurative lung disease. It is thought to be due to the so-called “vicious cycle” of abnormal mucus clearance leading to bacterial colonization, then neutrophilic inflammation, then airway distortion and destruction followed by further abnormal mucus clearance. Historically bronchiectasis was often due to pulmonary tuberculosis. Currently it is well recognized that a long list of pulmonary disease can lead to bronchiectasis, including autoimmune disease, cilia abnormalities, trachobronchomegaly (Mounier-Kuhn), cartilage deficiency (Williams-Campbell), immune deficiencies including HIV infection as well as immunoglobulin deficiency, inflammatory bowel disease, malignancies including chronic lymphocytic lymphoma, stem cell transplantation and graft versus host disease, yellow nail syndrome, alpha one antitrypsin deficiency, obstructing tumor or foreign body, childhood infections or pneumonias, aspiration and smoke inhalation injuries.
Case Continued:
Further history was obtained and it was revealed that during a previous hospital admission three years earlier, her IgE was elevated at 3189 ɥg/ml. Previous pulmonary function testing had revealed an FEV1/FVC ratio of 0.40 with a FEV1 of 1.55 L (48% predicted). Post-bronchodilator FEV1 had increased by >12% and 200 ml. Residual volume was 118% predicted value and total lung capacity was 109% predicted. Her diffusion capacity for carbon monoxide was elevated at 112% predicted value.
With this information the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) was strongly considered. A repeat IgE was ordered along with Aspergillus specific immunoglobulins, serum precipitins and skin reactivity testing.
Which of the following is/are true about the diagnosis of ABPA? (Click on the correct answer to proceed to the third of six panels)