20th February 2025

A 43-year-old woman with recurrent, difficult to treat asthma exacerbations presents with worsening breathlessness and wheezing.

A 43-year-old woman with recurrent, difficult to treat asthma exacerbations presents with worsening breathlessness and wheezing. She has also reported malaise, leg swelling and intermittent joint pains.

Her blood pressure is 168/93 mmHg. Her urine dipstick shows 3+ blood and 2+ protein. Her creatinine is 334 micromol/L (normal: 55 – 120 micromol/L) with a prior result 1 year ago of 93 micromol/L. Her WCC is 13.8 x 109/L (normal: 4-11 x 109/L) with neutrophils of 7.5 x 109/L (normal: 2-7 x 109/L). Her eosinophils are 5.3 x 109/L (normal: 0.1-0.4 x 109/L).

A historic skin prick testing for sensitivity to Aspergillus fumigatus antigens was negative. Prior total IgE, IgE to Aspergillus fumigatus and IgG antibody to Aspergillus precipitins were negative.

Chest radiograph shows bilateral peripheral opacifications in the lung fields and subsequent CT of her thorax shows peripheral consolidation and ground-glass changes.

Given the likely diagnosis, what would be the most likely positive blood test from the following options?

Select the SINGLE most appropriate option from the list below. Select ONE option only.