Charlene C. Gottlieb, MD, Chief Resident in Medicine, Jewish Hospital of St Louis: A 32-year-old man with a 15-year history of bronchial asthma presented with episodes of bronchospasm, which had increased over the past year and necessitated several bursts of prednisone. In the past nine months, he had had three roentgenologically documented episodes of pneumonia involving different areas of the lung.
On physical examination, the patient's temperature was 38.1°C. Diffuse wheezing was heard throughout the chest. The white blood cell count was 12 000 mm3 (12.0 × 109/L) with 28% (0.28) eosinophils. Skin tests to pollens and molds were positive, including a 4+ prick test to Aspergillus fumigatus. Serum precipitins were strongly positive for A fumigatus. The total serum IgE level was 3400 ng/mL (3840 μg/L). Prednisone therapy (60 mg/d) was begun, with rapid improvement in the chest roentgenogram and the clinical state.
Raymond G. Slavin, MD,