Sinobronchial Allergic Mycosis: Results
Stringent diagnostic criteria for ABPM and AFS were used for inclusion of case reports in this study. Diagnostic criteria for AFS, as previously published by us, include the following: (1) radiologic evidence of sinusitis of one or more paranasal sinuses; (2) histopathologic identification of fungal elements in eosinophil-rich allergic mucin; (3) the absence of invasive fungal disease; and (4) the absence of diabetes, immunodeficiency, or the use of immunosuppressive drugs. Criteria for the diagnosis of ABPM include the presence of asthma and fungal-specific IgE by skin test or RAST, plus any three of the following: (1) elevated total serum IgE levels; (2) peripheral eosinophilia; (3) current or previous pulmonary infiltrates; or (4) central bronchiectasis.
Eight case reports of patients with concomitant AFS and ABPM were identified in the literature. Canadian health & care mall more Four of the cases did not meet our diagnostic criteria for AFS and ABPM. A 48-year-old woman reported by Travis et al did not meet the criteria for ABPM, although testing of a biopsy specimen from a right upper lobe lung nodule did reveal allergic mucin. The patient had no history of asthma or CF, did not demonstrate the presence of fungal-specific IgE by skin test or RAST, and did not have radiographic evidence of central bronchiectasis. A second patient in this same series had no evidence of peripheral eosinophilia or radiographic evidence of bronchiectasis. A third patient not included did not meet criteria for the diagnosis of either AFS or ABPM. Silver stains of sinus material were negative for fungi, and there were no pulmonary infiltrates or radiographic evidence of bronchiectasis. A recent case reported in the New England Journal of Medicine23 of a patient with chronic sinusitis, pulmonary nodules, and hemoptysis met the criteria for the diagnosis for AFS but did not meet the criteria for ABPM. Specifically, the patient did not have eosin-ophilia, and there were no skin test results or IgE levels provided. The authors reported that they suspected that the patient had invasive pulmonary aspergillosis.