Acute exacerbation of bronchial asthma with allergic bronchopulmonary aspergillosis (ABPA) and hyper IGE syndrome: A case report

Kasthuri.R1*, Esthar Rani2

1Nursing Supervisor, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

2Nursing Superintendent, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

*Correspondence

Abstract

Acute exacerbation of bronchial asthma is a common medical emergency that can lead to severe respiratory distress if not treated promptly. Allergic Bronchopulmonary Aspergillosis (ABPA) is an immunological lung disorder caused by hypersensitivity to Aspergillus species and is frequently associated with asthma. Hyper IgE syndrome is a rare primary immunodeficiency characterized by elevated serum IgE levels and recurrent infections. This case report describes the successful initial management of a 20-year-old male with acute asthma exacerbation complicated by ABPA and Hyper IgE syndrome.

Key words: Allergic Bronchopulmonary Aspergillosis (ABPA); Hyper IgE syndrome; Bronchial asthma

Introduction

Bronchial asthma is a chronic inflammatory airway disease characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and cough. ABPA develops due to an exaggerated immune response to aspergillus fumigatus, leading to airway inflammation and bronchiectasis if untreated. Hyper IgE syndrome further increases susceptibility to recurrent respiratory infections, making disease management more challenging. Early recognition and prompt treatment are essential to reduce morbidity and improve patient outcomes.

Case Presentation

A 20-year-old male with a known history of bronchial asthma, Allergic Bronchopulmonary Aspergillosis (ABPA), and Hyper IgE syndrome presented with complaints of progressive breathlessness for five days. The patient also had a history of fever for three days but denied chest pain, nausea, vomiting, or loose stools.

On examination, the patient was conscious and oriented, but tachypnea and tachycardia appeared with the use of accessory muscles of respiration. His pulse rate was 134 beats/minute, blood pressure was 160/80 mmHg, and oxygen saturation was 68% on room air, which improved to 98% with 10 L/min oxygen supplementation. Respiratory examination revealed bilateral wheezing.

Investigation

Routine laboratory investigations were performed to evaluate the patient’s condition. The findings supported the diagnosis of acute exacerbation of bronchial asthma associated with ABPA and Hyper IgE syndrome.

Management

The patient received immediate oxygen therapy along with bronchodilator nebulization, systemic corticosteroids, antibiotics, and supportive treatment. Continuous monitoring of vital signs and oxygen saturation was maintained throughout the hospital stay. The patient’s respiratory distress gradually improved with treatment.

Despite clinical improvement, the patient requested discharge due to personal reasons. The medical team explained the need for continued inpatient care; however, the patient opted for Discharge Against Medical Advice (DAMA).

Diet Plan

On 5th day dietary recall was conducted. The patient’s daily energy intake ranged from 1099-1562 kcal with protein intake ranging from 40.8-66.2 g/day. The diet was planned based on the patient’s nutritional requirements

Dietary Intervention

The planned diet emphasized protein-rich, anti-inflammatory and potassium-rich foods. The menu included oats, banana, amla, papaya, pomegranate, brown rice, green gram, spinach, carrot, sweet potato, chapathi, paneer, almonds, and turmeric milk. Adequate hydration was encouraged through water, fresh juices, and soups. Processed, fried, and highly refined foods were minimized.

The planned diet provided approximately 1312 kcal and 52.5 g protein/day with adequate fibre and potassium according to the prescribed requirements. Potassium-rich foods were recommended with consideration of the patient’s potassium status and potassium supplementation.

Benefits

The diet provides essential nutrients to support immune function, tissue repair, muscle maintenance, electrolyte balance, energy production, and digestive health. Fruits and vegetables provide antioxidants and vitamins, while protein-rich foods support recovery and help prevent muscle wasting. Anti-inflammatory foods such as turmeric may provide additional nutritional support for respiratory health.

Discharge Condition

At the time of discharge, the patient was afebrile and hemodynamically stable. His pulse rate was 91 beats/minute, blood pressure was 90/60 mmHg, and oxygen saturation was 96% on room air.  The patient tolerated the diet well and was clinically stable at discharge. Continued dietary and medical management was advised.

Discharge Medications

The patient was discharged with:

  • Glycohale nebulization
  • Foracort nebulization
  • Halcef-O 200 mg
  • Predmet (tapering dose)
  • Nexpro 20 mg
  • Mondeslor 10 mg
  • Piriton CS syrup

He was advised to gargle after nebulization, avoid exposure to allergens, continue medications regularly, and attend follow-up after 15 days.

Discussion

Patients with bronchial asthma complicated by ABPA and Hyper IgE syndrome are at increased risk of recurrent exacerbations and respiratory complications. Corticosteroids remain the cornerstone of treatment for controlling airway inflammation, while bronchodilators provide symptomatic relief. Patient education regarding medication adherence, allergen avoidance, and regular follow-up is essential to prevent disease progression. Discharge against medical advice may increase the risk of relapse and rehospitalization.

Conclusion

This case highlights the importance of early diagnosis and prompt management of acute bronchial asthma exacerbation associated with ABPA and Hyper IgE syndrome. Comprehensive treatment, patient counseling, and close follow-up are crucial for achieving better clinical outcomes and reducing future exacerbations.

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