A 23-year-old man is experiencing a flare of his asthma. He is using his salbutamol inhaler more frequently than usual and despite increasing his inhaled steroids he is still short of breath. Previously his asthma was considered mild with no severe exacerbations requiring oral steroids or hospitalization. With his flare, he has recurrent episodes of bronchial obstruction, fever, malaise, and expectoration of brownish mucous plugs. On examination, there is bilateral wheezing. The heart, abdomen, neurologic, and skin exams are normal. CXR reveals upper lobe pulmonary infiltrates; the eosinophil count is 3000/mL, and serum precipitating antibodies to Aspergillus are positive. Which of the following is the most likely diagnosis?
Allergic bronchopulmonary aspergillosis (in asthmatics), parasitic reactions, and drugs are known causes of pulmonary eosinophilia. Idiopathic causes include Loeffler's syndrome (benign, acute eosinophilic pneumonia), chronic eosinophilic pneumonia, hyper eosinophilic syndrome, and Churg-Strauss allergic granulomatosis.
ascaris infestation
allergic bronchopulmonary aspergillosis
Churg-Strauss allergic granulomatosis
Loeffler's syndrome
Respiratory