This form of aspergillosis is not invasive. The affected alveoli are packed with eosinophils. Granulomatous interstitial pneumonitis, with peribronchial and alveolar septal infiltration by plasma cells, mononuclear cells, and numerous eosinophils, may be present. The number of bronchiolar mucous glands and goblet cells may be increased. Proximal bronchiectasis develops in advanced cases.
Fibrosis can lead to severe, irreversible airway obstruction.
The patient usually presents with an exacerbation of bronchial asthma and may have an intermittent low-grade fever and systemic symptoms. Serial chest x-rays show transient shadows that may migrate from lobe to lobe. Mucus plugs may produce atelectasis. CT is useful in delineating bronchiectasis, which usually occurs in proximal airways. Bronchograms should not be performed.