Tuberc Respir Dis.  2011 Oct;71(4):278-281.

Allergic Bronchopulmonary Aspergillosis Coupled with Sinusitis in a Nonasthmatic Patient

• Park SW
• Choi JC
• Kim JY
• Park IW
• Choi BW
• Shin JW

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a complex clinical entity resulting from an allergic immune response to Aspergillus species, and most often occurs in patients with asthma. ABPA is rarely observed in the absence of asthma, which is, in fact, the principal criterion for its diagnosis. Our patient was a 53-year-old woman with no history of bronchial asthma. She presented with a 1-month history of cough, mucopurulent nasal discharge, and localized pulmonary consolidation. Peripheral blood eosinophilia and elevated serum IgE were observed. Sinus radiography showed right maxillary sinusitis. Pathologic examination of bronchoscopic biopsy specimens revealed conglomerates of fungal hyphae. Pulmonary function and bronchial provocation tests were within normal ranges. The patient was successfully treated for 3 months with itraconazole and oral prednisolone. There has been no evidence of recurrence over a 7-month follow-up. ABPA coupled with sinusitis in a nonasthmatic patient is a very rare occurrence and warrants reporting.

Keyword

Aspergillosis, Allergic Bronchopulmonary; Sinusitis; Asthma

MeSH Terms

Aspergillosis, Allergic Bronchopulmonary
Aspergillus
Asthma
Biopsy
Bronchial Provocation Tests
Cough
Eosinophilia
Female
Follow-Up Studies
Humans
Hyphae
Immunoglobulin E
Itraconazole
Maxillary Sinus
Maxillary Sinusitis
Middle Aged
Prednisolone
Recurrence
Reference Values
Sinusitis
Immunoglobulin E
Itraconazole
Prednisolone

Figure

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  Figure 1 (A) Opacities in the left lower lung field. (B) Right maxillary sinusitis. (C) Complete endobronchial obstruction with high-attenuation material within the lingular division of the left upper lobe bronchus. (D) Associated peribronchial consolidation with central necrotic portions in the lingular division of the left upper lobe.

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  Figure 2 (A) Fungal ball consists of concentric layers of Aspergillus hyphae and eosinophil clusters arranged in a laminar pattern (HE, ×100). (B) The organism has regular, homogeneous hyphae with parallel contours and regular septa (PAS, ×400).

Reference

1. Rosenberg M, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1977. 86:405–414.

2. Kauffman HF. Immunopathogenesis of allergic bronchopulmonary aspergillosis and airway remodeling. Front Biosci. 2003. 8:e190–e196.

3. Slavin RG, Fischer VW, Levine EA, Tsai CC, Winzenburger P. A primate model of allergic bronchopulmonary aspergillosis. Int Arch Allergy Appl Immunol. 1978. 56:325–333.

4. Hoshino H, Tagaki S, Kon H, Shibusa T, Takabatake H, Fujita A, et al. Allergic bronchopulmonary aspergillosis due to Aspergillus niger without bronchial asthma. Respiration. 1999. 66:369–372.

5. Berkin KE, Vernon DR, Kerr JW. Lung collapse caused by allergic bronchopulmonary aspergillosis in non-asthmatic patients. Br Med J (Clin Res Ed). 1982. 285:552–553.

6. Koh WJ, Han J, Kim TS, Lee KS, Jang HW, Kwon OJ. Allergic bronchopulmonary aspergillosis coupled with broncholithiasis in a non-asthmatic patient. J Korean Med Sci. 2007. 22:365–368.

7. Amin MU, Mahmood R. Multiple bronchoceles in a non-asthmatic patient with allergic bronchopulmonary aspergillosis. J Pak Med Assoc. 2008. 58:514–516.

8. Greenberger PA, Patterson R. Allergic bronchopulmonary aspergillosis and the evaluation of the patient with asthma. J Allergy Clin Immunol. 1988. 81:646–650.

9. Greenberger PA. Diagnosis and management of allergic bronchopulmonary aspergillosis. Allergy Proc. 1994. 15:335–339.

10. Shah A, Panchal N, Agarwal AK. Concomitant allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis: a review of an uncommon association. Clin Exp Allergy. 2001. 31:1896–1905.

11. Shah A, Khan ZU, Chaturvedi S, Malik GB, Randhawa HS. Concomitant allergic Aspergillus sinusitis and allergic bronchopulmonary aspergillosis associated with familial occurrence of allergic bronchopulmonary aspergillosis. Ann Allergy. 1990. 64:507–512.

12. Sher TH, Schwartz HJ. Allergic Aspergillus sinusitis with concurrent allergic bronchopulmonary Aspergillus: report of a case. J Allergy Clin Immunol. 1988. 81:844–846.

13. Bhagat R, Shah A, Jaggi OP, Khan ZU. Concomitant allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis with an operated aspergilloma. J Allergy Clin Immunol. 1993. 91:1094–1096.