Allergic bronchopulmonary aspergillosis - CHEST Publications ...

hea, headache, and epistaxis. Occasionally, the
allergic fungal sinusitis may extend into adjacent
spaces such as the orbit and manifest as proptosis.
243 Although in many patients with ABPA,
sinusitis can often be radiologically demonstrated,
it may not be possible to confirm the diagnosis of
AAS because many patients decline to undergo the
diagnostic procedures required to establish the
diagnosis. We currently label the patients with
ABPA as having concomitant AAS if there is
combination of hyperattenuating mucus and/or
bony erosion on a paranasal CT scan. Treatment is
initiated for ABPA with patients receiving additional
intranasal glucocorticoids. If the symptoms
persist or are troublesome, surgical management
may be required for the management of AAS.
Conclusions
A high index of suspicion for ABPA should be
maintained while managing any patient with bronchial
asthma whatever the severity or the level of
control. Host immunologic responses are central to
the pathogenesis, and they are the primary determinants
of the clinical, biologic, pathologic, and radiologic
features of this disorder. ABPA may precede
the clinical recognition of the disorder for many
years or even decades, and it is often misdiagnosed as
a variety of pulmonary diseases. Because a patient
with ABPA can be minimally symptomatic or asymptomatic,
all patients with bronchial asthma should be
routinely screened with an Aspergillus skin test. In
patients with Aspergillus hypersensitivity, further
immunologic studies are warranted to diagnose
ABPA before the development of bronchiectasis
because bronchiectasis is a poor prognostic marker
in the natural history of this disease.
ACKNOWLEDGMENT: The author wishes to thank Dr. Amanjit
Bal, Assistant Professor, Department of Histopathology,
PGIMER, Chandigarh for providing the histopathology photographs.
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