S A T U R D A Y 170 Eleven Year Follow Up of an African-American Adolescent with Destructive Sinus Disease and Intermittent Asthma Diagnosed with Allergic Fungal Sinusitis (AFS) and Incidentally Found to have Allergic Bronchopulmonary Mycosis (ABPM) A. G. Hall, A. E. Morris, G. D. Marshall, Jr; University of Mississippi Medical Center, Jackson, MS. RATIONALE: AFS is a noninvasive fungal sinusitis in individuals with fungal-specific IgE, intractable sinusitis, and nasal polyposis. ABPM is suggested to be lower airway manifestation of similar process. In rare cases, these diseases have occurred concomitantly. To our knowledge, no cases of AFS and ABPM in the same patient have been reported for this length of time. METHODS: Spirometry, CT sinuses and chest, total IgE, endoscopic sinus surgery, bronchoscopy. RESULTS: Initial presentation of this 17yo African-American male has been reported (Chest 2002;121:1670-6). After initial diagnosis in 2000, he received frequent prednisone bursts for exacerbations. Beginning in 2004, he required chronic prednisone for progression of bronchiectasis. IgE peaked at 8222 IU/mL before chronic steroids initiated, decreasing to 2000s-4000s while asymptomatic and in response to steroid bursts, and spiking to 6000s during exacerbations. Spirometry demonstrated improvement from moderate-severe obstruction to mild obstruction on prednisone. Six years following initial sinus surgery he had recurrence of nasal polyps with impacted allergic mucin and bony destruction requiring further surgical intervention. While off prednisone for 10 months in 2009, he had acute hemoptysis. CT showed cystic bronchiectasis and soft tissue lung mass concerning for systemic fungal infection versus lymphoma. Bronchoscopy confirmed APBM exacerbation. Since then he has remained stable in stage 4 ABPM with multiple attempts at weaning prednisone. CONCLUSIONS: His clinical course highlights challenges associated with managing AFS and ABPM over time. It also raises the question whether to consider screening for ABPM in patients with AFSwho present with even mild lower respiratory symptoms including intermittent asthma.