chronic invasive granulomatous sinusitis associated with invasion of paranasal tissues and proptosis. While frequently referred to in the literature, an actual case has never been reported endemic to the United States (US). We recently treated a 25 year old woman from St. Louis in whom we made the diagnosis of PPAG. Microscopy of a sinus mucosal biopsy revealed profuse fungal growth with regional tissue invasion and noncaseating granulomas with multinucleated giant cells and plasma cells. Exploring the idea that there may be an immune-mediated pathogenesis, we sought to characterize her immune status. ELISA assays for A flavus specific IgG and IgE antibodies were performed. Serum precipitins to A flavus were measured by gel immunodiffusion. The patient’s immunocompetence was assessed by measuring total serum IgG, IgA and IgM Ievels and by performing in vitro lymphocyte proliferation studies. The results of the ELISA studies revealed elevated A flavus specific IgG and IgE. Serum precipitins to A flavus were present. Serum immunoglobulin levels and in vitro lymphocyte proliferation shldies were normal, suggesting immunocompetency. Upon examination of our data from this first endemic case of PPAG in the US and that of cases reported from the Sudan and Northern India, we conclude that PPAG may not be simply an infectious process, but may involve an immunologic component in its pathophysiology.
Full conference title:
2000 American Academy of Allergy, Asthma, and Immunology Annual Meeting
- AAAAI 2000 (56th)