Chest
Opinions/HypothesesSinobronchial Allergic Mycosis: The SAM Syndrome
Section snippets
Case Report
A 17-year-old, African-American, male, high school athlete with mild intermittent asthma presented to the University of Mississippi Medical Center for the evaluation of chronic sinusitis. A physical examination demonstrated an edematous nasal mucosa, nasal polyps, and thick mucus. Bilateral wheezes were present on auscultation of the chest. Despite long-term antibiotic therapy and therapy with topical nasal steroids, his symptoms of nasal obstruction and intermittent purulent discharge
Materials and Methods
Computer-based literature searches were used to identify all case reports of concomitant AFS and ABPM in the medical literature published in English (MEDLINE; National Library of Medicine; Bethesda, MD). These case reports were carefully reviewed, and the findings were compared to those for our patient.
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,4 include the following: (1)
Results
Eight case reports of patients with concomitant AFS and ABPM were identified in the literature.17,18,19,20,21,22,23 Four of the cases did not meet our diagnostic criteria for AFS and ABPM.21,22,23 A 48-year-old woman reported by Travis et al21 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
Discussion
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). A classification of sinopulmonary syndromes is presented in Table 2. Patients with SAM are atopic individuals who have asthma, rhinosinusitis, and high levels of total and fungal-specific IgE. The common histopathologic findings of eosinophilic mucin with layers of cellular debris and
ACKNOWLEDGMENT
The authors thank Drs. Steven Bigler and John Conforti for their helpful review of the histopathologic and radiographic features of this patient, and Doris Miller, Karen Davis, and Dawn Chism for assisting with the preparation of the manuscript.
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Allergic fungal rhinosinusitis: What we can learn from allergic bronchopulmonary mycosis
2023, Allergology InternationalAllergic fungal rhinosinusitis
2018, Journal of Allergy and Clinical ImmunologyCitation Excerpt :However, this analogy between Aspergillus species–induced pulmonary and sinus disease oversimplifies what is now known to be a much more complex array of mechanisms that underlie both disease processes. This probably explains current data showing that ABPA and allergic Aspergillus species–related rhinosinusitis are observed only occasionally in the same patients, although their coexistence has been highlighted.12,13 Subsequently, other patients were reported to have analogous presentations with rhinosinusitis and allergic mucin in association with fungal species other than Aspergillus species, such as Alternaria, Bipolaris, Curvularia, Drechslera, and Fusarium; this has led to introduction of the broader term allergic fungal sinusitis and, more recently, AFRS.14-18
Eosinophilic Lung Diseases
2016, Clinics in Chest MedicineCitation Excerpt :Familial cases have been reported.191 ABPA may be associated with allergic Aspergillus sinusitis,192 resulting in a syndrome called sinobronchial allergic aspergillosis.193 Patients with ABPA experience chronic cough, dyspnea, expectoration of brown or tan sputum plugs, low-grade fever, and chronic rhinitis.
Dematiaceous Molds
2016, Infectious Disease Clinics of North AmericaCitation Excerpt :This disease is similar in presentation to allergic bronchopulmonary aspergillosis (ABPA), which is typically seen in patients with asthma or cystic fibrosis.53 There is a suggestion that allergic fungal sinusitis and allergic bronchopulmonary mycosis may actually be a continuum of disease and should be referred to as sinobronchial allergic mycosis.54 Criteria for the diagnosis of ABPA in patients with asthma include (1) asthma, (2) positive skin test for fungal allergens, (3) elevated immunoglobulin E (IgE) levels, (4) Aspergillus-specific IgE, and (5) proximal bronchiectasis.53
Schizophyllum commune-induced allergic fungal rhinosinusitis and sinobronchial mycosis
2015, Medical Mycology Case ReportsCitation Excerpt :They termed this condition the SAM syndrome. Patients with SAM syndrome have chronic sinusitis involving multiple sinuses, asthma, cutaneous hyperreactivity to fungal allergens, eosinophilia, high serum IgE levels, and radiographic evidence of bronchiectasis, mass lesions to diffuse pulmonary infiltrates, and even normal findings [3]. Each case with S. commune-induced AFRS developed aspirin-sensitive asthma [13] and subclinical asthma as in our case (Table 1), suggesting that sensitization to S. commune can also cause allergy in the lower airway.
Eosinophilic Lung Diseases
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth Edition