Concomitant allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis: a review of an uncommon association*.
BACKGROUND
Although thought to have common immunopathological processes, concomitant occurrence of allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis (AAS) appears to be rarely reported as to date only five detailed case reports are available.


OBJECTIVE
To present a review of seven cases of concomitant ABPA and AAS, three of whom were earlier reported for their unusual presentations.


METHODS
Patients with ABPA with nasal symptoms were evaluated radiologically. Consent was taken for antral wash and/or Caldwell-Luc operation in those with radiological evidence of sinusitis and the material was sent for histopathological and mycological studies.


RESULTS
Of the 95 patients with ABPA, 22 had radiological evidence of sinusitis. Nine consented to surgery, seven of whom were diagnosed as concomitant AAS. Nasal symptoms preceded chest symptoms in two patients, vice versa in one and occurred simultaneously in four. Familial occurrence of ABPA, middle lobe syndrome and collapse with effusion along with an operated aspergilloma were seen in one patient each. Transient pulmonary infiltrates and central bronchiectasis were seen in all patients. Computed tomography of the paranasal sinuses, carried out in six patients, revealed mucosal thickening with hyperdense lesions, without any bony erosion or destruction. All patients had positive skin tests, positive precipitin study and raised total and specific IgE. Allergic mucin was seen in all patients, fungal hyphae in five, and culture grew Aspergillus spp. in four. All patients responded favourably to oral prednisolone.


CONCLUSIONS
Concomitant occurrence of ABPA and AAS seems to be infrequently recognized. Since asthma and sinusitis are often seen by two different specialities, the occurrence of AAS in ABPA and ABPA in AAS may easily be overlooked.
Shah
A
A
Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India. ashokshah99@hotmail.com
Panchal
N
N
Agarwal
A K
AK
D000293:Adolescent; D000328:Adult; D001228:Aspergillosis; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D001232:Aspergillus fumigatus; D005192:Family Health; D005260:Female; D006801:Humans; D007159:Immunologic Tests; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000737:chemistry / Q000276:immunology; D013902:Radiography, Thoracic; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D012882:Skin Tests; D013147:Spirometry