Allergic Aspergillus sinusitis and its association with allergic bronchopulmonary aspergillosis

Abstract

Allergic Aspergillus sinusitis (AAS) is a three decade old clinicopathologic entity in which mucoid impaction akin to that of allergic bronchopulmonary aspergillosis (ABPA) occurs in the paranasal sinuses. Features such as radiographic evidence of pansinusitis, passage of nasal plugs and recurrent nasal polyposis in patients with an atopic background is suggestive of AAS. Histopathlogic confirmation from the inspissated mucus is a sine qua non for the diagnosis. Heterogeneous densities on computed tomography of the paranasal sinuses are caused by the 'allergic mucin' in the sinuses. Many patients give a history of having undergone multiple surgical procedures for symptomatic relief. The current approach to treatment appears to include an initial surgical debridement followed by postoperative oral corticosteroids for long durations. Although both ABPA and AAS are classified as Aspergillus-related hypersensitivity respiratory disorders, their co-occurrence appears to be an infrequently recognised phenomenon. This could perhaps be attributed to the fact that these two diseases are often treated by two different specialties. A high index of suspicion is required to establish the diagnoses of ABPA and AAS. All patients with asthma and/or rhinosinusitis along with sensitisation to Aspergillus antigens are at an increased risk of developing ABPA and/or AAS. ABPA must be excluded in all patients with AAS and vice versa. Early diagnosis and initiation of appropriate therapy could plausibly alter the course of the disease processes and prevent the possible development of long term sequelae.

A clinicopathological and microbiological study of fungal rhinosinusitis

“…The common presenting symptoms were nasal obstruction (100%), headache (83%), nasal discharge (66%), facial pain (50%), olfactory disturbance (41%), halitosis (33%), epistaxis (25%) and fever (16%) which coincided with the study done by Chakrabartiet al 10 The associated factors were found to be allergy (66%) and asthma (16%) which coincided with the study done by Chandramani Panjabi et al 11 The risk factors associated were found to be diabetes mellitus (33%), usage of immunosuppressive drugs (8%). The prospective study done by Amin et al, 12 found underlying immunocompromised state in the form of haematological malignancy and poorly controlled diabetes mellitus in 22.2% of cases.…”

A review of 42 asthmatic children with allergic bronchopulmonary aspergillosis

“…The radiological finding suggestive of AAS includes hyperdense lesions, ‘star-filled sky’ or ‘ground glass’ pattern. These occur due to the presence of high-density mineral element produced by the fungal elements [ 38 ]. The occurrence of upper airways symptoms and sinusitis has been documented in children with asthma [ 39 ].…”

Allergic aspergillosis of the respiratory tract

“…Initiation of appropriate therapy could alter the natural course of the disease and prevent endstage lung fibrosis [61]. Furthermore, the occurrence of AAS in ABPA and ABPA in AAS should always be investigated [186,215].…”