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Paranasal aspergillosis – a spectrum of disease

Nasal and paranasal sinus aspergillosis has classically been described as having four types: allergic, non-invasive, invasive and fulminant (Sarti and Lucente, 1988). The allergic form is akin to allergic bronchopulmonary aspergillosis and is thought to be a combination of type I and type III immune responses to Aspergillus antigens (Katzenstein et al., 1983; Waxman et al., 1987). Non-invasive disease results from the formation of an aspergilloma or fungus ball and behaves as a chronic sinusitis. Both these forms are considered saprophytic, extramucosal disease, benign in nature (Hartwick and Batsakis, 1991). The invasive form as described by Hora (1965) behaves like a malignant neoplasm presenting with a facial mass and proptosis. It is slowly progressive and locally destructive. Fulminant disease (McGill etal., 1980) is angio invasive, rapidly destructive and often fatal. The histopathological changes associated with these clinical forms have been well described by Milroy et al. (1989). However analysis of previously reported cases does not demonstrate clear distinctions of type or such closely associated patterns of clinical behaviour.