Allergic Bronchopulmonary Aspergillosis: A Masquerade of Difficult to Control Asthma

Background Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to a common fungus Aspergillus which colonizes the airways of patients with asthma and cystic fibrosis. Characterized by chronic bronchial inflammation, eosinophilia, airway remodeling, and bronchiectasis, it presents clinically with worsening symptoms of cough and breathlessness that is difficult to control. Early diagnosis and rapid implementation of proper management are critical to prevent complications and/or disease progression. Although latest criteria depends on positive serology and typical radilogical findings associated with the disease, atypical presentation can occur thus a high index of suspicion is necessary. We describe a case of 16 year old female with difficult to control asthma diagnosed as ABPA in absence of any identifiable imaging findings.