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Pulmonology Quiz

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35 year old with long standing history of asthma which has been worsening over the past year.  His asthma has been poorly controlled and he has had persistent cough and mucus plugs. 

Physical exam is remarkable for faint expiratory wheezing.

Chest xrays have shown fleeting pulmonary infiltrates and central bronchiectasis.  Sputum cultures have been negative, fungal cultures have been positive for aspergillus.

All of the following would help confirm the patient's diagnosis except?

  1.  IgE < 100 IU/dL
  2.  Positive skin test for aspergillus fumigatus
  3.  Positive test IgG for aspergillus precipitins
  4.  Eosinophilia