ABPA Concomitantly Occurring with Invasive Sinus Aspergillosis: A Short Report on Two Patients

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that is caused by hypersensitivity to Aspergillus fumigatus with resultant systemic immune activation, chronic asthma, recurrent pulmonary infiltrates, and bronchiectasis. First described by Hinson et al. (Thorax 7:317-333 [1]) in 1952, this disease occurs in 1-2% of patients with persistent asthma and in 2-15% of patients with cystic fibrosis (Greenberger, Front Biosci 8:s119-s127 [2]). Although the diagnostic criteria for ABPA have been laid down (and include bronchial asthma, immediate skin test reactivity to A. fumigatus, elevated total serum IgE level, pulmonary infiltrates, central bronchiectasis, peripheral blood eosinophilia, and positive serum precipitins [IgG] against Aspergillus antigen), none of these are specific for ABPA (Shah, Curr Opin Pulm Med 13(1):72-80 [3]). There is still no consensus on the number of criteria needed for diagnosis, and patients in different stages of ABPA may not fulfill all these criteria (Greenberger, Front Biosci 8:s119-s127 [2]; Chakrabarti et al., Mycoses 45:295-299 [4]). An high-resolution CT (HRCT) scan showing central bronchiectasis and high attenuation mucus is presently the investigation of choice for the diagnosis of bronchiectasis in patients with ABPA (Shah, Front Biosci 8:e138-e146 [5]). ABPA has also been reported in association with allergic fungal rhinosinusitis in English literature (Shah, Curr Opin Pulm Med 13(1):72-80 [3]). We are reporting two patients with invasive aspergillosis of the nose, paranasal sinuses and orbit, who were diagnose and managed successfully for ABPA, a previously unreported entity.