Case Report: Atypical pediatric allergic bronchopulmonary aspergillosis masquerading as recurrent pneumonia

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Abstract
Allergic bronchopulmonary aspergillosis (ABPA), a hypersensitivity lung disease mediated by Aspergillus fumigatus , represents a frequently overlooked diagnosis in pediatric practice. We describe an 11-year-old girl with difficult-to-treat asthma and recurrent pneumonias (three episodes within one year) in whom comprehensive evaluation revealed borderline total IgE (678 IU/mL), Aspergillus -specific IgE of 5.81 kUA/L, high-resolution CT demonstrating bilateral infiltrates with scattered nodules, and Aspergillus fumigatus identification via bronchoalveolar lavage fluid culture and targeted next-generation sequencing (tNGS). Initiation of systemic corticosteroids plus itraconazole produced rapid clinical resolution within three weeks, decreased total IgE by 29% (to 479 IU/mL) at one month, and achieved marked radiographic improvement by four months. This case highlights the need to consider ABPA in children with difficult-to-treat asthma and recurrent pulmonary infections, suggests Aspergillus -specific IgE screening in difficult-to-treat asthma, while diagnosis should rely on integrated clinical, immunologic, radiologic, and microbiologic assessment.

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