PMC6549302_01
Computed tomography of chest. a High attenuation mucus plug in right intermediate bronchial trunk, and right pleural effusion. b Infiltration in right lung field
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Fig1
Chest X-ray and CT scan obtained in December 2017 revealed high-attenuation mucus plug in right intermediate bronchial trunk, right pleural effusion (Fig. 1a), and infiltration in the right lung field (Fig. 1b). 
Computed tomography of paranasal sinuses revealing high-attenuation mucus plug in the left ethmoid sinus similar to that observed in the right intermediate bronchial trunk
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Fig2
CT of paranasal sinuses obtained to investigate nasal congestion for 3 years, revealed high-attenuation mucus plug in the left ethmoid sinuses (Fig. 2).
a Bronzed, hard, sticky mucus plug in the right intermediate bronchial trunk, which was challenging to retrieve. Multiple biopsy specimens collected from the mucus plug, causing slight bleeding from the bronchial wall. b Bronzed, hard, sticky mucus plug in the left ethmoid sinuses
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Fig3
Bronchoscopy for definite diagnosis confirmed bronze-colored, hard mucus plug in the right intermediate bronchial trunk (Fig. 3a), and pathological examination of multiple biopsy specimens stained by hematoxylin-eosin revealed allergic mucin with layers of mucus, eosinophils, and eosinophil-predominant mixed inflammatory cell infiltrate and Charcot-Leyden crystals (Fig. 4a). We performed open biopsy of the ethmoid sinuses and found similar mucus plug there, which revealed similar pathological findings in the right intermediate bronchial trunk (Fig. 3b), including fungal hyphae with a 45  branch angle within allergic mucin (Fig. 4c).
a Hematoxylin-eosin staining of allergic mucin with layers of mucus, eosinophils, eosinophil-predominant mixed inflammatory cell infiltrate and Charcot-Leyden crystals. Original magnification, x200. b Grocott's staining showing fungal hyphae with a 45  branch angle within allergic mucin. Original magnification, x400. c Grocott's staining showing fungal hyphae within the maxillary sinus. Original magnification, x400
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Fig4
Grocott's stain revealed fungal hyphae with a 45  branch angle within the allergic mucin (Fig. 4b).
a-c Computed tomography scan of the lung and paranasal sinuses showing apparent amelioration with treatment
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Fig5
CT of the lung and paranasal sinuses showed apparent amelioration (Fig. 5a-c), and nasal congestion was resolved after 3 months steroid therapy.