Allergic aspergillus sinusitis: Concepts in diagnosis and treatment of a new clinical entity

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.