Contemporaneous occurrence of allergic bronchopulmonary aspergillosis, allergic Aspergillus sinusitis, and aspergilloma

Background

The clinical categories of Aspergillus-related respiratory disorders usually remain mutually exclusive. The coexistence of allergic bronchopulmonary aspergillosis (ABPA) with aspergilloma is uncommon, whereas concurrent ABPA and allergic Aspergillus sinusitis (AAS) is rare. The association of these 3 clinical entities has previously been documented only once in a patient who had earlier been operated on for an aspergilloma before the diagnoses of ABPA and AAS were established.

Objective

To describe an adult in whom ABPA, AAS, and aspergilloma were diagnosed simultaneously.

Methods

Spirometry, radiography, computed tomography, skin allergy testing with Aspergillus antigens, serum precipitins against Aspergillus, total and specific IgE, functional endoscopic sinus surgery, and fungal culture were performed.

Results

A 26-year-old man who had asthma and rhinitis since childhood presented with hemoptysis. Serial chest radiographs revealed transient pulmonary infiltrates and an aspergilloma. Computed tomography of the thorax confirmed the aspergilloma and showed bilateral central bronchiectasis along with patchy infiltrates. Strong bands of precipitins were detected against Aspergillus fumigatus, and intradermal testing with Aspergillus antigens elicited strong type I and III hypersensitivity reactions. Specific IgE and IgG antibodies against A fumigatus were positive, and total IgE levels were significantly elevated. Peripheral blood eosinophilia was also detected. Sinus involvement was confirmed on computed tomography, and pathologic material obtained by functional endoscopic sinus surgery demonstrated allergic mucin that contained fungal elements. In addition, A fumigatus was cultured.

Conclusions

ABPA, AAS, and aspergilloma can occur simultaneously in the same patient.