A seven year old boy presented with history of recurrent respiratory distress with wheezing since five years of age. There is a history of an allergic rash since two year of age that has often accompanied these episodes. Moreover, there was family history of atopy and asthma. In this case also there was no socio-environmental cause of asthma exacerbation. On clinical examination there was clubbing and evidence of increased work of breathing (subcostal suction, bilateral wheeze and crepitations). A chest x-ray revealed bilateral patchy pulmonary opacities (Fig. 4). A transient improvement was recorded post bronchodilator therapy.
Investigations revealed a total leukocyte count of 13,500/mm3 with 6% eosinophil (absolute eosinophil count of 800/mm3). Serum IgE level was elevated at 2500ng/ml. Tests were negative for tuberculosis. Sweat chloride estimation and CFTR gene mutation was negative thereby ruling out cystic fibrosis. HRCT chest showed changes suggestive of bronchiectasis, 'signet ring sign' (Fig. 5). Skin prick tests were positive for Aspergillus fumigatus and Aspergillus versicolor. Serum IgE antibodies specific against Aspergillus fumigatus was found to be positive. As like the other patient, the patients responded favourably to treatment (oral corticosteroids alone of total 2 months duration).