Multiple clinical syndromes are associated with pulmonary aspergillosis. Immunocompetent hosts are affected by hypersensitivity lung diseases including allergic bronchopulmonary aspergillosis and hypersensitivity pneumonitis; the features of these entities have been reviewed. In both conditions, pulmonary eosinophilia may be present, and corticosteroids are effective treatment. Invasive aspergillosis typically occurs in immunocompromised patients and is frequently fatal. We have found only one report of invasive disease in immunocompetent children, although several adults have been affected. Exposure to a large innoculum, as occurred in our patient, has been suggested as a cause of invasive disease in normal hosts.
The absence of wheezing and a history of asthma made a diagnosis of ABPA unlikely in our patient. His presentation was more consistent with a form of hypersensitivity pneumonitis, but the absence of cutaneous reactivity and initially, of precipitating antibodies, is atypical. Given the lack of evidence of active infection, eosinophilic pneumonia is a diagnosis of exclusion.