Allergic bronchopulmonary aspergillosis as presenting sign of cystic fibrosis in an elderly man

Background: Although cystic fibrosis is the most common genetic disorder of children, its heterogeneous spectrum of severity lends itself to underdiag nosis in the older adult patient population where the index of suspicion is not high. Methods: We report a 60-year-old Hispanic man with asthma who presented wit h progressive dyspnea and wheezing unresponsive to inhaled corticosteroid t reatment. Additionally, he had clinical findings and a past history suggest ive of cystic fibrosis. Skin testing, radiography and laboratory studies we re completed to evaluate for allergic bronchopulmonary aspergillosis (ABPA) and cystic fibrosis. Results: Test results revealed peripheral eosinophilia and hyper IgE. Skin testing to Aspergillus fumigatus (Af) was positive. IgG, lgM, and Af specif ic antibodies were present. High resolution CT scan showed central bronchie ctasis. Sweat tests were positive on two separate occasions and gene analys is showed our patient to have a positive gene mutation at D127ON/D127ON. Conclusion: Cystic fibrosis should be suspected in the older adult patient with a compatible clinical presentation.