Allergic Bronchopulmonary Candidiasis: An Uncommon Case of Hypereosinophilia

Allergic Bronchopulmonary Candidiasis: An Uncommon Case of Hypereosinophilia Micosis broncopulmonar alrgica por Candida: un caso poco comn de hipereosinofilia Dear Editor,We present the case of a 42-year-old woman, never-smoker, immunocompetent, with no recent travel or relevant treatment, history of nasal polyposis, employed in cleaning.She was referred for suspected bronchial asthma with mucopurulent sputum, intermittent cough and wheezing, predominantly at night.Pulmonary function tests showed no obstruction and a bronchodilator test was negative.Blood tests revealed peripheral eosinophilia of 940 cells/L and total immunoglobulin E (IgE) of 400 IU/mL.Highresolution computed tomography of the chest revealed cylindrical bronchiectasis in the middle lobe and right and left lower lobes, filled with mucous material (Fig. 1).We performed a differential diagnosis for hypereosinophilia.IgE and IgG against Aspergillus, prick tests and recombinants were negative, ruling out allergic bronchopulmonary aspergillosis (ABPA).Eosinophilic granulomatosis with polyangiitis was excluded with ANCA antibodies and negative nasal biopsy.A parasitic origin and primary hypereosinophilic syndromes were also ruled out by the haematology unit.Genetic studies for primary ciliary dyskinesia and cystic fibrosis were negative.A bronchoscopy was performed for bronchoalveolar lavage (BAL) and bronchial aspiration (BAS), showing 48% eosinophilia and isolation of Candida albicans which was considered non-relevant.Given the peripheral blood eosinophilia and BAL eosinophils > 25%, chronic eosinophilic pneumonia was considered a diagnosis of exclusion.Prednisone 0.5 mg/kg per day was started with clinical improvement, but it could not be reduced below 10 mg daily.After several lung function tests, airflow variability was observed [FVC,