The diagnosis of allergic bronchopulmonary aspergillosis (ABPA) may be difficult when the major criteria are not present or when the clinical, laboratory, and radiographic findings have been altered by prior corticosteroid therapy. However, the early diagnosis of ABPA is important because it may lead to the prevention of evolution to the corticosteroid-dependent asthma stage (stage IV) or fibrotic lung disease stage (stage V). The clinical histories of 3 ABPA patients are reviewed to demonstrate that these patients may appear in different stages of ABPA and with markedly varied presentations. The high index of suspicion required for diagnosis of ABPA deserves emphasis as does the importance of excluding a diagnosis of ABPA in all asthmatics with immediate skin reactivity to Aspergillus fumigatus.
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