A Case of Allergic Bronchopulmonary Aspergillosis that Improved with Endoscopic Sinus Surgery for Fungal Sinusitis

Herein, we report a case of allergic bronchopulmonary aspergillosis (ABPA) that showed improvement at the follow-up visit of the patient after endoscopic sinus surgery (ESS) for fungal sinusitis. A 59-year-old woman initially visited the department of respiratory medicine for an abnormal opacity on the chest X-ray. She had a history of bronchial asthma and recurrent pneumonia. After careful clinical examinations, she was diagnosed as having ABPA, treated for asthma, and advised to return for regular follow-up examinations. One year later, she visited our department complaining of nasal discharge and nasal obstruction, and sinus computed tomography (CT) revealed a soft tissue density, mainly in the left maxillary sinus. Since the serum total immunoglobulin E (IgE) level and peripheral blood eosinophil count were elevated and the test for Aspergillus-specific IgE antibody was also positive, we suspected allergic fungal rhinosinusitis (AFRS) with concomitant ABPA. ESS was performed, with complete removal of the fungal debris from the sinuses. On histopathology, Aspergillus species were detected in the fungal debris, but no eosinophilic inflammation was found in the sinus mucosa, suggesting the diagnosis of noninvasive fungal sinusitis. Postoperative chest CT showed improvement of the abnormal opacity on the chest x-ray and reduction of both the serum total IgE level and peripheral blood eosinophil count. Further improvement was achieved with the use of itraconazole for one more year. Clinical observations in this case strongly suggest that removal of fungi from the sinuses by upper airway sinus surgery might result in improvement of the lower airway symptoms of ABPA.