# Miliary Nodules in the Lungs Not Always Due to Tuberculosis: A Report of a Rare Case

## TL;DR

A rare case of allergic bronchopulmonary aspergillosis (ABPA) presented with miliary nodules in the lungs without a history of asthma.

## Contribution

This case report highlights ABPA as a rare cause of miliary nodules in patients without asthma.

## Key findings

- Miliary nodules can be a rare radiological manifestation of ABPA.
- ABPA can occur in patients without a prior asthma diagnosis.
- Early diagnosis of ABPA is crucial to prevent fibrotic complications.

## Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a disease that occurs due to a pulmonary immune system reaction to the antigens of Aspergillus Fumigatus. Central bronchiectasis, mucoid impaction, mosaic attenuation, centrilobular nodules, and tree-in-bud opacities are the most commonly observed CT scan findings of ABPA. Miliary molting is one of the rare radiological manifestations of ABPA. ABPA is usually seen in uncontrolled asthma and is very uncommon in patients without a prior history of asthma. We are reporting a case of ABPA that presented a miliary nodule in radiology and was never diagnosed as a case of asthma previously. Thus, in a patient with eosinophilia and miliary molting, ABPA is to be excluded. Early diagnosis and treatment can prevent end-stage fibrotic ABPA.