Allergic Bronchopulmonary Aspergillosis Presenting With Pulmonary Solid Lesions and Elevated Serum Carcinoembryonic Antigen Mimicking Lung Cancer

Sep 30, 2026

Case report describing allergic bronchopulmonary aspergillosis (ABPA) that imitated lung cancer through pulmonary solid lesions and elevated serum carcinoembryonic antigen (CEA). A 39-year-old woman with asthma presented with cough and dyspnea, and chest CT showed solid lesions in the left upper lobe with mediastinal lymphadenopathy. PET-CT suggested malignancy by increased FDG uptake, but CT-guided biopsy and other tests confirmed ABPA using ISHAM criteria; corticosteroids improved both imaging and CEA levels. Conclusions emphasize considering ABPA in asthmatic patients with solid lesions plus high CEA to prevent unnecessary invasive procedures and misdiagnosis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Background

Case Report

Clinical Presentation

Conclusions

e-ISSN 1941-5923 © Am J Case Rep, 2025; 26: e947770 DOI: 10. 12659/AJCR.947770 Received: 2024.12.20 Accepted: 2025.10.10 Available online: 2025.11.15 Published: 2025.12.21 Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G BEF B B B B B Corresponding Author: Financial support: Conflict of interest: Allergic Bronchopulmonary Aspergillosis Presenting With Pulmonary Solid Lesions and Elevated Serum Carcinoembryonic Antigen Mimicking Lung Cancer Heling Wu Tiange Qu Shenwen Yi Jun Xu Fei Yu Liang Ye Department of Respiration, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, PR China Liang Ye, e-mail: [yeliang0988@163.com](yeliang0988@163.com) This study was supported by the Medical Science and Technology Development Project Fund of Nanjing (No. ZKX21041) None declared Patient: Female, 39-year-old Final Diagnosis: Allergic bronchopulmonary aspergillosis Symptoms: Cough • dyspnea • wheezing Clinical Procedure: — Specialty: Pulmonology Objective: Unusual clinical course Background: Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that occurs in patients allergic to Aspergillus species. It is typically characterized by reversible airway obstruction, transient pulmonary infiltrates, eosinophilia, and fever. Chest radiographs and high-resolution computed tomography (CT) are essential for diagnosis and differential diagnosis. Carcinoembryonic antigen (CEA), a tumor-specific marker, is often elevated in various malignant tumors but can also be increased in nonmalignant conditions. This overlap can result in misdiagnosis and unnecessary anxiety, leading to inappropriate clinical management. We report a case of ABPA presenting with pulmonary shadows that mimicked lung cancer, as well as elevated serum CEA levels. This report aims to enhance clinicians’ understanding of ABPA, improve diagnostic accuracy, and reduce the likelihood of misdiagnosis or missed diagnosis. Case Report: A 39-year-old woman with a history of bronchial asthma presented with a productive cough. Chest CT revealed solid lesions in the left upper pulmonary lobe with mediastinal lymphadenopathy. Her serum CEA level was elevated, raising suspicion of malignancy. A positron emission tomography-CT scan demonstrated increased fluorodeoxyglucose uptake in the lungs. However, a CT-guided percutaneous lung biopsy, combined with other relevant diagnostic tests, confirmed ABPA according to the International Society for Human and Animal Mycology (ISHAM) criteria. After corticosteroid therapy, both the radiographic findings and serum CEA levels improved. Conclusions: To avoid unnecessary invasive procedures and misdiagnosis of malignancy, ABPA should be considered in the differential diagnosis of patients with asthma who present with pulmonary solid lesions and elevated serum CEA levels. Keywords: Aspergillosis, Allergic Bronchopulmonary • Carcinoembryonic Antigen • Lung Diseases, Fungal Full-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/947770](https://www.amjcaserep.com/abstract/index/idArt/947770) 1375 — 3 12 Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher This work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) e947770-1 Indexed in: [PMC] [PubMed] [Emerging Sources Citation Index (ESCI)][Web of Science by Clarivate] Wu [H. et](H. et) al: ABPA with pulmonary solid lesions mimicking lung cancer © Am J Case Rep, 2025; 26: e947770 Introduction Allergic bronchopulmonar

FAQs

Why can ABPA be mistaken for lung cancer in this scenario?

ABPA can present with pulmonary solid lesions and elevated serum CEA, a marker commonly associated with malignancy. This biochemical and imaging overlap can lead to misinterpretation as lung cancer.

What diagnostic evidence confirmed ABPA instead of malignancy?

CT-guided percutaneous lung biopsy, along with other relevant diagnostic tests, confirmed ABPA according to ISHAM criteria despite malignancy-suggesting PET-CT findings.

What treatment outcome was observed after corticosteroid therapy?

After corticosteroid therapy, both radiographic findings and serum CEA levels improved, supporting ABPA rather than cancer as the underlying cause.

Sep 30, 2026

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