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Wednesday 01 June 2005

[Allergic fungal sinusitis and allergic broncho-pulmonary aspergillosis: a fortuitous association or a nosological rhino-bronchial entity?]

By: Braun JJ, Pauli G, de Blay F.

Rev Mal Respir 2005 Jun;22(3):405-11

INTRODUCTION: The identification of allergic fungal sinusitis (AFS) is much more recent than that of allergic broncho-pulmonary aspergillosis (ABPA) and may still be incomplete and controversial. Their association has been only rarely reported in the literature. Is it a matter of a fortuitous association or of a well defined and/or new nosological rhino-bronchial entity? METHODS: A retrospective study was undertaken from a series of 10 cases of AFS with 4 cases associated with ABPA and fulfilling all the diagnostic criteria described in the literature. RESULTS: The association of AFS and ABPA may be concomitant (2 cases) or not (2 cases) with a possible time lag of several years between the onset of naso-sinal and broncho-pulmonary disease, even after recovery from the original episode. Treatment comprising steroids, endoscopic surgery (4 cases) combined with anti-fungal drugs (2 cases), led to resolution (2 cases), a considerable improvement (1 case) and therapeutic failure in 1 case (follow up longer than 4 years in all cases). CONCLUSION: The association, concomitant or remote in time, of AFS and ABPA emphasises the unity of the upper and lower airways as well as the pathophysiological relationship between these two fungal respiratory diseases. The prevalence of this association remains low and the treatment is not standardised.

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