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Fungal Hyphae-Containing Eosinophilic Bronchial Mucus Plugs in Patients with Allergic Bronchopulmonary Aspergillosis Without Asthma Symptoms
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A1279 - Fungal Hyphae-Containing Eosinophilic Bronchial Mucus Plugs in Patients with Allergic Bronchopulmonary Aspergillosis Without Asthma Symptoms
Author Block: O. Narumoto1, A. Konno1, Y. Nakamura2, J. Suzuki1, H. Tashimo1, M. Kitani1, S. Akashi1, A. Hebisawa1, H. Matsui1, K. Ohta1; 1Tokyo National Hospital, Kiyose, Tokyo, Japan, 2Toho University, Tokyo, Japan.
Introduction: Aspergillus lung infection is classified into three categories; i.e. invasive and chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis (ABPA). We often encounter patients with fungal hyphae-containing bronchial mucus plugs similar to ABPA but without asthma symptoms. Current diagnostic criteria does not allow these patients diagnosed with ABPA, or other categories. There have been case reports describing similar cases as ABPA without asthma. However, the frequency of such cases has not been investigated and is not clear.
Historically, mucus plugs with eosinophils and fungal hyphae have been considered as important histopathological features since the time when ABPA was first described in 1952 by Hinton. Bosken et al. described mucus plugs with eosinophils and fungal hyphae were diagnostic of ABPA. However, the Rosenberg-Patterson criteria referred to mucus plugs in only minor criteria, and the new diagnostic criteria proposed by International Society for Human and Animal Mycology (ISHAM) working group in 2013 had no reference to mucus plugs, putting more weight on immunological tests.
In this study, we focused on cases with fungal hyphae-containing mucus plugs, and investigated the proportion of cases without asthmatic symptoms, which meet the ABPA criteria except for asthma.
Methods: A total of 97 patients with pathological examination of mucus plugs were retrospectively selected from January 1992 to December 2016. Medical records were reviewed regarding the diagnosis of ABPA and bronchial asthma.
Results: Among 97 patients with mucus plugs, 55 patients had mucus plugs with eosinophils and fungal hyphae.
An median peripheral blood eosinophil count of 55 patients was 1197 (839-1840) count/μl and IgE level was 2464 (461-6936) IU/ml. Positive aspergillus skin test or elevated IgE levels against Aspergillus fumigatus (A. fumigatus) were observed in 100% of patients. Precipitating serum antibodies to A. fumigatus was positive in 65.3% (32/49, 6 missing data) of patients. Previous diagnosis of bronchial asthma or asthmatic symptoms were observed in 65.5% (36/55) of patients. With the diagnostic criteria by ISHAM working group, 52.7% (29/55) of patients were diagnosed with ABPA. One quarter of patients (25.4%, 14/55) did not meet the ABPA criteria by ISHAM due only to the absence of bronchial asthma, and could be considered ABPA without asthma.
Conclusion: Substantial number of cases with fungal hyphae-containing eosinophilic bronchial mucus plugs met ABPA criteria except for asthma symptoms. ABPA without asthma may be more common than previously thought.
Author Block: O. Narumoto1, A. Konno1, Y. Nakamura2, J. Suzuki1, H. Tashimo1, M. Kitani1, S. Akashi1, A. Hebisawa1, H. Matsui1, K. Ohta1; 1Tokyo National Hospital, Kiyose, Tokyo, Japan, 2Toho University, Tokyo, Japan.
Introduction: Aspergillus lung infection is classified into three categories; i.e. invasive and chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis (ABPA). We often encounter patients with fungal hyphae-containing bronchial mucus plugs similar to ABPA but without asthma symptoms. Current diagnostic criteria does not allow these patients diagnosed with ABPA, or other categories. There have been case reports describing similar cases as ABPA without asthma. However, the frequency of such cases has not been investigated and is not clear.
Historically, mucus plugs with eosinophils and fungal hyphae have been considered as important histopathological features since the time when ABPA was first described in 1952 by Hinton. Bosken et al. described mucus plugs with eosinophils and fungal hyphae were diagnostic of ABPA. However, the Rosenberg-Patterson criteria referred to mucus plugs in only minor criteria, and the new diagnostic criteria proposed by International Society for Human and Animal Mycology (ISHAM) working group in 2013 had no reference to mucus plugs, putting more weight on immunological tests.
In this study, we focused on cases with fungal hyphae-containing mucus plugs, and investigated the proportion of cases without asthmatic symptoms, which meet the ABPA criteria except for asthma.
Methods: A total of 97 patients with pathological examination of mucus plugs were retrospectively selected from January 1992 to December 2016. Medical records were reviewed regarding the diagnosis of ABPA and bronchial asthma.
Results: Among 97 patients with mucus plugs, 55 patients had mucus plugs with eosinophils and fungal hyphae.
An median peripheral blood eosinophil count of 55 patients was 1197 (839-1840) count/μl and IgE level was 2464 (461-6936) IU/ml. Positive aspergillus skin test or elevated IgE levels against Aspergillus fumigatus (A. fumigatus) were observed in 100% of patients. Precipitating serum antibodies to A. fumigatus was positive in 65.3% (32/49, 6 missing data) of patients. Previous diagnosis of bronchial asthma or asthmatic symptoms were observed in 65.5% (36/55) of patients. With the diagnostic criteria by ISHAM working group, 52.7% (29/55) of patients were diagnosed with ABPA. One quarter of patients (25.4%, 14/55) did not meet the ABPA criteria by ISHAM due only to the absence of bronchial asthma, and could be considered ABPA without asthma.
Conclusion: Substantial number of cases with fungal hyphae-containing eosinophilic bronchial mucus plugs met ABPA criteria except for asthma symptoms. ABPA without asthma may be more common than previously thought.
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