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©2013 UpToDate ® Print Email Chronic cavitary aspergillosis transformed from ABPA Longstanding asthma, ABPA with chronic cavitary pulmonary aspergillosis. The patient suffered a long history of severe steroid-dependent asthma with recurrent infective exacerbations culture positive for Aspergillus fumigatus and Pseudomonas aeruginosa . An Aspergillus precipitins test was positive with an elevated total IgE level. Despite initial treatment with oral itraconazole, chest radiograph deteriorated, showing cystic cavities in both apices, and a CT scan showing a right upper lobe mycetoma (fungal ball). She developed respiratory failure and was established on long-term oxygen therapy of 2 L/min via an oxygen concentrator at home and oxygen conserver when mobile. Systemic steroids, nebulizers, and long-term itraconazole did not prevent disease progression of ABPA to chronic cavitary aspergillosis. She was treated with voriconazole for >5 years with some benefit, although very slow deterioration requiring 4 L/min oxygen 24 hours a day. Reproduced with permission from: The Aspergillus Website (file://www.aspergillus.org.uk/). Copyright © 2010.