Four other patients met the diagnostic criteria and were included with our patient to form the five case reports used in our analysis. The patients were 17 to 55 years of age, and the group included three men and two women. Presenting complaints varied from purulent nasal discharge and obstruction to chest discomfort with cough and fever (Table 1).
All five patients had a history of chronic sinusitis, and four of the five had undergone sinus surgery prior to diagnosis. All of the patients had a history of asthma. Chest radiographic findings at the time of diagnosis ranged from normal to diffuse pulmonary infiltrates with or without pleural effusion and a mass lesion. Four of five patients had current or previous pulmonary infiltrates, and all had radiographic evidence of bronchiectasis. Four of five patients had elevated serum IgE levels, and all of the patients had peripheral eosinophilia. All patients experienced clinical responses to corticosteroids at a dose of 0.5 mg/kg/d. No long-term data were presented in any case report. Clinical findings in these five patients were not dissimilar from the four patients who did not meet criteria for inclusion in our study.
The five convincing case reports of patients with concomitant AFS and ABPM reviewed here clearly demonstrate that these diseases occur together and constitute a syndrome of sinobronchial allergic mycosis (SAM). Canadian family pharmacy online website A classification of sinopulmonary syndromes is presented in Table 2. Patients with SAM are atopic individuals who have asthma, rhinosinus-itis, and high levels of total and fungal-specific IgE. The common histopathologic findings of eosinophilic mucin with layers of cellular debris and scant degenerating hyphae in both the upper and lower airways support the conclusion that these are similar hypersensitivity reactions to fungal elements occurring at different locations in the same airway.
Table 1—Clinical Characteristics of Patients With SAM at Time of Diagnosis
|Study/Age, yr/Sex||Presenting Complaints||ChronicSinusitis||PreviousSinusSurgery||Initial Chest Radiograph||ICR||Elevated Total IgE (Normal Range)||L И 3-O >E ll el c||Outcome|
|Sher andSchwartz/42/F||Purulent nasal discharge and obstruction||+||+||Normal||+||13,084 ng/mLt||1,355||Controlled with CCS 1 mo later|
|Shah andKhan/24/M||Right-sided chest discomfort and productive cough||+||+||Bilateral infiltrates||+||5,600 IU/mLt||837||Controlled with CCS 2 yr later|
|Bhagat et al/38/F||Left-chest discomfort,productive cough, wheeze, and rhinitis||+||+||Left-sided infiltrate with pleural effusion||+||280 IU/L (0-14 IU/L)||1,116||Controlled with CCS 1 mo later|
|Shah et al/55/M||Right-sided chest discomfort, productive cough, and fever||+||+||Right middle-lobe infiltrate||+||Not reported||2,002||Controlled with CCS 1 mo later|
|Present/17/M||Purulent nasal discharge and obstruction||+||Left upper-lobe mass||+||6,330 kU/L (< 160 kU/L)||1,652||Controlled with CCS 6 mo later|
Table 2—Sinopulmonary Syndromes
|Immotile cilia syndrome|