Abstract
BackgroundAllergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS) are characterized by hyper-responsiveness of the respiratory tract and the nasal cavity and paranasal sinuses, respectively to Aspergillus species and AFRS causes chronic rhinosinusitis. Herein, we report the first case of sinobronchial allergic mycosis (SAM) syndrome, defined as ABPA with concomitant AFRS, caused by Aspergillus fumigatus patient > 80 years.Case presentationAn 82-year-old male with interstitial pneumonia who returned for follow-up exhibited high-attenuation mucus plug in the right intermediate bronchial trunk, infiltration in the right lung field, and right pleural effusion on regular chest computed tomography (CT). We found unilateral central bronchiectasis in the right upper lobe. Similarly, CT scan of the paranasal sinuses revealed high-attenuation mucus plugs in left ethmoid sinuses. Biopsy specimens from the plugs in the right intermediate bronchial trunk and the left ethmoid sinuses revealed allergic mucin with layers of mucus eosinophils, eosinophil-predominant mixed inflammatory cell infiltrate and Aspergillus hyphae. The patient fulfilled all the major criteria for ABPA and AFRS, and was diagnosed with SAM syndrome. CT scan of the lung and paranasal sinuses revealed apparent amelioration after oral steroid therapy.ConclusionDespite mostly reported in relatively young patients, SAM syndrome can occur in elderly individuals as well.
Highlights
Allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS) are characterized by hyper-responsiveness of the respiratory tract and the nasal cavity and paranasal sinuses, respectively to Aspergillus species and AFRS causes chronic rhinosinusitis
Despite mostly reported in relatively young patients, sinobronchial allergic mycosis (SAM) syndrome can occur in elderly individuals as well
Concurrent ABPA and AFRS are defined as sinobronchial allergic mycosis (SAM) syndrome [1]
Summary
Aspergillus species can cause various allergic diseases, such as allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS). We report the case of an 82-year-old male who simultaneously developed ABPA and AFRS and was diagnosed with SAM syndrome. Case report An 82-year-old male was diagnosed with bronchial asthma at 10 years of age and treated with inhalants and he did not receive treatment for asthma since the age of 30 because of the resolution of bronchial asthma He was followed at our hospital for idiopathic interstitial pneumonia by annual regular chest X-ray and computed tomography (CT) scans for 4 years. We performed open biopsy of the ethmoid sinuses and found similar mucus plug there, which revealed similar pathological findings in the right intermediate bronchial trunk (Fig. 3b), including fungal hyphae with a 45° branch angle within allergic mucin (Fig. 4c). There has been about 1 year and 4 months after the diagnosis, the patient is currently receiving oral steroid therapy (0.1 mg/kg) and remains in good condition with no deteriorations
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