2025年 · 第105卷第13期

The patient, a 45-year-old male, denied smoking history. He had a history of bronchial asthma for 3 years, and was treated with intermittent inhalation of budesonide and formoterol powder inhalation (160 μ g: 4.5 μ g), and his cough and wheezing symptoms were controlled smoothly. In March 2023, cough and wheezing worsened, and the local hospital gave anti-infection and other treatments that were not effective, and sputum plugs were coughed up intermittently (Figure 1). In May 2023, he visited the Department of Respiratory Medicine, Ninth Medical Center, PLA General Hospital. Chest CT showed multiple bronchial mucous plugs in both lungs, some of which were high density (Figures 2 and 3, arrows), and the CT value was as high as 220 HU. The percentage of blood eosinophils was 11.3% and the blood eosinophils were 0.75×10⁹/L, serum total immunoglobulin E (IgE) was 229 kU/L, Aspergillus fumigatus-specific IgE was 0.62 kU/L, and Aspergillus fumigatus immunoglobulin G (IgG) antibody was negative. No bacteria and fungi were observed in alveolar lavage fluid culture, and no bacteria and fungi were observed in metagenomic second-generation sequencing (mNGS). The forced expiratory volume (FEV1) at the first second of the pulmonary function test was 1.79 L, FEV1 accounted for 49.0% of the predicted value, FEV1/forced vital capacity (FVC) was 49.8%, the relaxation test was positive, FEV1 increased by 580 ml, the improvement rate was 32.8%, and exhaled nitric oxide (NO) was 183 ppb. Allergic bronchopulmonary aspergillosis (ABPA) was diagnosed. Prednyl acetate was administered 30 mg once/d and tapered, along with inhalation of budegefor inhalation aerosol (160 μ g: 7.2 μ g: 4.8 μ g), 2 inhalations, 2 times/d, without antifungal therapy. After 2 months of treatment, the patient's cough and wheezing improved significantly, and the pulmonary function improved. Chest CT reexamination on July 10 showed that the bronchial mucus plug disappeared, with residual local bronchiectasis (Figure 4, arrow), and blood eosinophils were 0.03×10⁹/L, total serum IgE was 234 kU/L, pulmonary function test FEV1 accounted for 109.1% of the predicted value, FEV1/FVC was 77.6%, and exhaled NO was 51 ppb. Follow-up until March 2024, the patient was inhaled budesonide formoterol powder inhalation alone (160 μ g: 4.5 μ g), 2 inhalations, 2 times/d, and the condition was stable without recurrence. The 2024 International Society of Human and Zoomycology Allergic Bronchopulmonary Aspergillosis Guidelines include high-density mucus plugs as one of the diagnostic criteria for ABPA. High-density mucus plugs are defined as mucus plugs with higher density than paravertebral muscles on high-resolution CT, with CT density values>70 HU as the cut-off value.