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Allergic Aspergillus sinusitis: concepts in diagnosis and treatment of a new clinical entity
Abstract:
The clinical features in 15 young adult patients with allergic Aspergillus sinusitis includes a history of asthma, recurrent nasal polyps, and radiographic evidence of pansinusitis. Multiple surgical procedures were performed on 12 patients. The histologic diagnosis is made on the mucinous material which contains eosinophils, fungal hyphae (Aspergillus species), and Charcot-Leyden crystals. Mycetomas, direct mucosal and soft tissue invasion by fungi, were not observed. Immunologic findings include an immediate cutaneous reactivity to Aspergillus in 60% of patients, total serum IgE elevation in 85%, and serum precipitins to Aspergillus in 85%. A new therapeutic protocol was devised based on the current treatment of allergic bronchopulmonary aspergillosis. Therapy includes wide local debridement, adequate sinus aeration, and the postoperative use of systemic steroids. Seven patients placed on systemic corticosteroids are asymptomatic for a mean of 14 months. Diagnosis of allergic Aspergillus sinusitis requires a high index of suspicion, a confirmatory diagnosis from the inspissated mucus, and an immunologic evaluation prior to the institution of corticosteroid therapy.
Insights
Allergic Aspergillus sinusitis in young adults presents with asthma and nasal polyps. A new treatment protocol involving surgery and systemic steroids shows promising results for symptom relief.
Area of Science:
- Otolaryngology
- Allergy and Immunology
- Mycology
Background:
- Allergic Aspergillus sinusitis (AAS) is an emergent fungal rhinosinusitis.
- It is characterized by allergic response to Aspergillus species in the sinuses.
Purpose of the Study:
- To describe clinical features, diagnosis, and treatment outcomes of AAS in young adults.
- To propose a new therapeutic protocol for AAS.
Main Methods:
- Retrospective review of 15 young adult patients with AAS.
- Histologic examination of mucinous material for eosinophils, fungal hyphae, and Charcot-Leyden crystals.
- Immunologic evaluation including skin reactivity, total IgE, and Aspergillus precipitins.
Main Results:
- Common clinical features include asthma, recurrent nasal polyps, and pansinusitis.
- Histology revealed eosinophils, Aspergillus hyphae, and Charcot-Leyden crystals; no tissue invasion observed.
- Immunologic findings: 60% positive skin reactivity, 85% elevated total IgE, 85% positive precipitins.
- A new protocol of surgical debridement, sinus aeration, and postoperative systemic steroids led to asymptomatic status in 7 patients for a mean of 14 months.
Conclusions:
- AAS diagnosis requires high suspicion, characteristic mucus findings, and immunologic evaluation.
- The proposed therapeutic protocol, including systemic corticosteroids, is effective in managing AAS in young adults.