Finger-in-Glove Appearance of Allergic Bronchopulmonary Aspergillosis in a Chronic Obstructive Pulmonary Disease Patient Without Asthma or Cystic Fibrosis: A Case Report and Literature Review

Background Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus species, commonly observed in patients with asthma or cystic fibrosis. However, its occurrence in individuals with chronic obstructive pulmonary disease (COPD) is rare and not well-documented. Radiological findings such as the "finger-in-glove" sign on computed tomography (CT) scans can aid in diagnosis, but a high index of suspicion is required in atypical cases. ABPA can contribute to mucoid impaction, leading to progressive pulmonary dysfunction if left untreated. Case Presentation We report a unique case of ABPA in a patient with COPD who had no prior history of asthma or cystic fibrosis. The patient presented with worsening respiratory symptoms, and imaging studies revealed mucoid impaction with the characteristic "finger-in-glove" sign. Laboratory findings included peripheral eosinophilia and elevated serum IgE, supporting the diagnosis of ABPA. Management involved antifungal therapy and corticosteroids, followed by a tapering regimen, with prophylactic treatment for pneumocystis pneumonia (PCP) to prevent opportunistic infections. Follow-up pulmonary function tests demonstrated a moderate decline in diffusion capacity, necessitating continued monitoring for potential early interstitial lung disease (ILD) or pulmonary hypertension. Conclusions This case highlights the importance of considering ABPA in patients with COPD who present with mucoid impaction, even in the absence of traditional risk factors. A thorough differential diagnosis of eosinophilia in pulmonary disease is crucial to distinguish between hypersensitivity reactions and malignant myeloproliferative disorders, ensuring appropriate treatment strategies. Clinicians should maintain a high level of awareness for ABPA in COPD patients to facilitate timely diagnosis and management.