Sinobronchial Allergic Mycosis: Allergy
Investigation of frozen sections showed bronchiolar mucous impaction, allergic mucin, and rare hyphae with no evidence of tissue invasion. Functional endoscopic sinus surgery was performed with a right-sided polypectomy, anterior and posterior ethmoidectomy, maxillary antrostomy, and frontal recess dissection. Large quantities of polypoid material with a peanut butter consistency were removed from the sinuses further buy birth control pills online. A microscopic examination of material from the right ethmoid sinus showed allergic mucin with layers of mucus, squamous epithelial cells, eosinophils, and an eosinophil-predominant mixed inflammatory cell infiltrate. There were scant hyphae (Fig 4). Gomori methenamine-silver staining of the mucin revealed small quantities of degenerated fungal hyphae (Fig 5). A culture of material from the sinuses grew Chrysosporium species. Cultures of the material from the lung failed to grow any organisms.
The patient’s preoperative total WBC count was 5,900 cells/^L with 28% eosinophils. Postoperatively, his total serum IgE count was 6,330 kU/L (Specialty Laboratories; Santa Monica, CA; normal count, < 114 kU/L). The patient underwent skin testing with a battery of 60 inhaled allergens and the skin-prick test was positive for Alternaria, Drechslera, Curvularia, Stemphylium, Aspergillus species, Cladosporium, and a number of tree, grass, and weed allergens. Chrysosporium is not available for allergy skin testing or radioallergosorbent tests (RAST).
Material was obtained and commercial assays were performed to detect 87 of the most common mutations in the CF transmembrane conductance regulator (CFTR) gene. The assay utilizes polymerase chain reaction and dot blot with allele-specific oligonucleotide hybridization (Genzyme Genetics; Framingham, MA).
Figure 4. Hematoxylin-eosin stains of mucoid material from the left upper lobe of our patient showing large quantities of mucin containing dense accumulations of eosinophils and hexagonal Charcot-Leyden crystals. Similar findings were present in material taken from the sinus (original X500).
Figure 5. Gomori methenamine-silver stains of mucoid material from the right ethmoid sinus revealing fungal hyphae within allergic mucin. Similar findings were noted on stains of material from the lung (original X500).