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Al Nahwi FA, AlMomen A, Alkishi SA, Almolani F, Al Ameer MA, Alzubaidi AA, Suwayyid WK, Alkhars AZ. The different clinical presentations of pediatric allergic fungal sinusitis. J Surg Case Rep 2023; 2023:rjad149. [PMID: 37096120 PMCID: PMC10122072 DOI: 10.1093/jscr/rjad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/28/2023] [Indexed: 04/26/2023] Open
Abstract
In this paper, we aim to study the different clinical presentations of pediatric allergic fungal sinusitis (AFS) in the Eastern Province of Saudi Arabia, and to review the experience in the diagnosis & management of AFS in children at King Fahad Specialist Hospital. This study is a retrospective case series of pediatric patients diagnosed and managed as AFS at a tertiary referral hospital in Saudi Arabia. The clinical presentation of pediatric AFS varies widely and includes unilateral, unilateral with proptosis, bilateral, alternating, isolated sphenoid and extensive with intracranial & intraorbital involvements. Children with AFS present with different clinical features when compared to adults. Therefore, they require a high index of suspicion for evaluation and early aggressive treatment.
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Affiliation(s)
- Fawatim A Al Nahwi
- Department of Pediatric, Maternity and Children Hospital, Al Ahsa, Eastern Province, Kingdom of Saudi Arabia
| | - Ali AlMomen
- Department of Otolaryngology-Head and Neck Surgery, King Fahad Specialist Hospital, Dammam, Eastern Province, Kingdom of Saudi Arabia
| | - Sarah A Alkishi
- Department of ENT Head & Neck Surgery, Al Jaber ENT & Eye Hospital, Al Ahsa, Eastern Province, Kingdom of Saudi Arabia
| | - Fadhel Almolani
- Department of Radiology, King Fahad Specialist Hospital, Dammam, Eastern Province, Kingdom of Saudi Arabia
| | - Mohammed A Al Ameer
- Department of Dermatology, King Fahad Hospital, Al Ahsa, Eastern Province, Kingdom of Saudi Arabia
| | - Aziza A Alzubaidi
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz Hospital, Jeddah, Western Province, Kingdom of Saudi Arabia
| | - Wejdan K Suwayyid
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz Hospital, Jeddah, Western Province, Kingdom of Saudi Arabia
| | - Abdullah Z Alkhars
- College of Medicine, King Faisal University, Al Ahsa, Eastern Province, Kingdom of Saudi Arabia
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Lisac RR, Garber M, Mirza A, Shah CC. Allergic fungal rhinosinusitis presenting with intracranial spread along large sphenoidal emissary foramen. Med Mycol Case Rep 2021; 32:10-13. [PMID: 33511029 PMCID: PMC7817427 DOI: 10.1016/j.mmcr.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
Abstract A 13-year-old girl was admitted for headache, right periorbital swelling and erythema. CT imaging demonstrated right orbital preseptal cellulitis, severe pansinusitis and suspected epidural abscess. Brain MRI and sinus CT confirmed an epidural abscess in the right middle cranial fossa and a second extra-cranial abscess in the right infratemporal fossa along with large right sphenoidal emissary foramen. Drainage from sinus surgery confirmed allergic fungal rhinosinusitis. She was treated with prednisone and voriconazole. Allergic fungal rhinosinusitis can rarely extend intracranially. Sphenoid emissary foramen can act as a potential communication channel between sphenoid sinus and intracranial compartment. Emissary vein of Vesalius traverses the sphenoidal emissary foramen. Emissary vein of Vesalius connects the pterygoid plexus to the cavernous sinus. Allergic fungal rhinosinusitis generates fibrino-purulent material with “peanut butter” appearance.
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Affiliation(s)
- Robert R Lisac
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Matthew Garber
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Ayesha Mirza
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Chetan C Shah
- University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.,Nemours Children's Specialty Care - Jacksonville, Jacksonville, FL, USA.,Wolfson Children's Hospital, Jacksonville, FL, USA.,Mayo Clinic, Jacksonville, FL, USA
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3
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Chalam KV, Enghelberg M, Murthy RK. Allergic fungal sinusitis masquerading as cavernous sinus thrombosis. J Surg Case Rep 2020; 2020:rjaa233. [PMID: 32855797 PMCID: PMC7444314 DOI: 10.1093/jscr/rjaa233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/20/2020] [Indexed: 11/14/2022] Open
Abstract
Allergic fungal sinusitis (AFS), a noninvasive form of fungal sinusitis, is rarely seen in immunocompetent patients. Involvement of sphenoid sinus can result in proptosis and loss of vision. We report AFS masquerading as posterior cavernous sinus syndrome. A 59-year-old African-American man presented with right complete ptosis with ophthalmoplegia. After an initial work-up and imaging studies, patient underwent endonasal sphenoid surgery, which revealed characteristic 'allergic fungal mucin'. Cavernous sinus syndrome is a rare presenting clinical feature of allergic fungal sinusitis. Ophthalmologists should be aware of this rare presentation of relatively common otorhinological disease for timely referral and appropriate management.
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Affiliation(s)
- K V Chalam
- Department of Ophthalmology, Loma Linda University Medical School, Loma Linda, California
| | - Moises Enghelberg
- Department of Ophthalmology, Loma Linda University Medical School, Loma Linda, California
| | - Ravi K Murthy
- Department of Ophthalmology, Loma Linda University Medical School, Loma Linda, California
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Hemachandran N, Sharma S. Sinonasal Diseases Affecting the Orbit - A Radiological Pattern-Based Approach. Curr Probl Diagn Radiol 2020; 50:505-511. [PMID: 32828604 DOI: 10.1067/j.cpradiol.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/04/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
The orbit is surrounded on three sides by paranasal sinuses with only a thin rim of bone separating the 2 at each site, predisposing it to the risk of being affected by the diseases of primary sinonasal compartment. A wide range of sinonasal pathologies can show orbital involvement and may present mainly with orbital symptoms. While most of these are due to contiguous involvement, a few others may be caused by systemic diseases that often involve both, the orbit and the sinuses in a noncontiguous manner. In this article, we have classified these diseases based on their radiological appearances into 5 patterns: Pattern 1 - Fat stranding predominant, Pattern 2 - Soft tissue without bone destruction, Pattern 3 - Soft tissue with bone destruction, Pattern 4 - Bony pathologies, Pattern 5 - Sinus volume changes. Various pathologies have been classified into these patterns considering the most typical changes in each of the disease processes. We briefly review these patterns, their hallmark radiological signs, typical examples of each pattern as well as review the various diseases process highlighting their radiological appearances. Imaging plays a crucial role in identifying the epicentre of the disease process, narrowing down the differential diagnoses, identifying management modifying complications, planning the surgical management as well as in the follow up of several such lesions. This unique radiological approach, although not absolute, aims to provide a new insight and working algorithm to help narrowing down the differential diagnoses.
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Affiliation(s)
| | - Sanjay Sharma
- Department of Radiodiagnosis, AIIMS, New Delhi, India.
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Di Marco L, Pujo K, Molly D, Boibieux A, Ltaïef-Boudrigua A. [Allergic fungal rhinosinusitis: A diagnosis to evoke]. Presse Med 2018; 47:625-638. [PMID: 30041846 DOI: 10.1016/j.lpm.2018.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/08/2017] [Accepted: 04/04/2018] [Indexed: 10/28/2022] Open
Abstract
Among fungal infections of the nasal sinuses, allergic fungal rhinosinusitis is a recently described, relatively rare and little known pathology. Its diagnosis is based on: clinical criteria (it occurs in young immunocompetent patients, often associated with bilateral nasosinusal polyposis); pathological criteria (allergic mucin: eosinophilic mucus without invasion of the sinusal mucosa and observation of fungal hyphae on surgical samples); biological criteria (hypereosinophilia, total and specific antifungal IgE); and radiological criteria. The combination of tomodensitometry (heterogeneous hyperdense and diffuse filling of nasosinusal cavities with expanded borders and a distended appearance of the bony wall), and MRI scan (extensive character and lesional signal [hypo and asignal T1 and T2], and cerebriform aspect of the fungal process) strongly suggests the diagnosis. It is important to distinguish the most typical forms, as well as unusual forms of allergic fungal rhinosinusitis. Main differential diagnoses are represented by other forms of fungal nasosinusal infections with different treatment and prognosis.
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Affiliation(s)
- Lucy Di Marco
- Radiologie neuro-ORL et ostéo-articulaire, hôpital Edouard-Herriot, pavillon B, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
| | - Kevin Pujo
- Centre hospitalier de Valence, service d'ORL et chirurgie cervical faciale, 179, boulevard Maréchal-Juin, 26000 Valence, France
| | - Damien Molly
- Plateau technique de biologie, service d'anatomie et cytologie pathologiques, 2, rue Angélique-Ducoudray, 21079 Dijon, France
| | - André Boibieux
- Hôpital de la Croix-Rousse, maladies infectieuses et tropicales, 103, Grande-Rue de la Croix-Rousse, 69004 Lyon, France
| | - Aicha Ltaïef-Boudrigua
- Radiologie neuro-ORL et ostéo-articulaire, hôpital Edouard-Herriot, pavillon B, 5, place d'Arsonval, 69437 Lyon cedex 03, France
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Ni Mhurchu E, Ospina J, Janjua AS, Shewchuk JR, Vertinsky AT. Fungal Rhinosinusitis: A Radiological Review with Intraoperative Correlation. Can Assoc Radiol J 2017; 68:178-186. [DOI: 10.1016/j.carj.2016.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 10/19/2022] Open
Abstract
The interaction between fungi and the sinonasal tract results in a range of clinical presentations with a broad spectrum of clinical severity. The most commonly accepted classification system divides fungal rhinosinusitis into invasive and noninvasive subtypes based on histopathological evidence of tissue invasion by fungi. Invasive fungal rhinosinusitis is subdivided into acute invasive and chronic invasive categories. The chronic invasive category includes a subcategory of chronic granulomatous disease. Noninvasive fungal disease includes localized fungal colonization, fungal ball, and allergic fungal rhinosinusitis. Noninvasive disease is simply fungal material (or the products of the inflammatory reaction of the sinus mucosa) that fills the sinuses but does not invade tissue. Bone loss is related to expansion of the sinus(es). Invasive disease causes tissue destruction, such that it expands past the bony confines of the sinuses. It can rapidly spread, causing acute necrosis. Alternatively, there may be slow tissue invasion characterized by symptoms confused with normal sinusitis, but destruction of normal nasal and paranasal structures.
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Affiliation(s)
- Elaine Ni Mhurchu
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Javier Ospina
- Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver General Hospital and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Arif S. Janjua
- Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver General Hospital and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jason R. Shewchuk
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Alexandra T. Vertinsky
- Neuroradiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
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7
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deShazo RD, Stringer S, Skipworth LB. Possible allergic fungal sinusitis. Ann Allergy Asthma Immunol 2016; 116:290-4. [PMID: 27055989 DOI: 10.1016/j.anai.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/31/2015] [Accepted: 08/05/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Richard D deShazo
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Department of Pediatrics, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Scott Stringer
- Department of Otolaryngology and Communicative Sciences, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Leigh Baldwin Skipworth
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JAH, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:e1-e60. [PMID: 27365388 DOI: 10.1093/cid/ciw326] [Citation(s) in RCA: 1577] [Impact Index Per Article: 197.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Thomas F Patterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System
| | | | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, United Kingdom
| | - Jay A Fishman
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Vicki A Morrison
- Hennepin County Medical Center and University of Minnesota, Minneapolis
| | | | - Brahm H Segal
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and Roswell Park Cancer Institute, New York
| | | | | | - Thomas J Walsh
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | | | - John E Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
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9
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Tong J, Jefferson N, Chaganti J, Fraser CL. Compressive Optic Neuropathy from Allergic Fungal Sinusitis. Neuroophthalmology 2015; 39:236-239. [PMID: 27928361 DOI: 10.3109/01658107.2015.1056380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/13/2022] Open
Abstract
Ophthalmic manifestations of allergic fungal sinusitis (AFS) are rare, but can occur in advanced disease. A 32-year-old man with advanced AFS presented with severe bilateral vision loss and restricted ocular motility. Magnetic resonance imaging and histological analysis confirmed active chronic AFS. Functional endoscopic sinus surgery was performed, with adjunctive steroid therapy. Although AFS is a reasonably well-recognised entity, severe disease causing bilateral visual deficits is rarely encountered. This can confound the diagnosis and appropriate treatment. Ophthalmologists should thus be aware of compressive optic neuropathy as a complication of advanced AFS to prompt early treatment and mitigate visual loss.
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Affiliation(s)
- Jessica Tong
- Department of Ophthalmology, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia
| | - Niall Jefferson
- Department of Ear, Nose and Throat, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia
| | - Joga Chaganti
- Department of Neuroradiology, St. Vincent's Hospital , Sydney, Darlinghurst, New South Wales, Australia , and
| | - Clare L Fraser
- Save Sight Institute , Sydney, New South Wales, Australia
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10
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Categorization and clinicopathological features of chronic rhinosinusitis with eosinophilic mucin in a korean population. Clin Exp Otorhinolaryngol 2015; 8:39-45. [PMID: 25729494 PMCID: PMC4338090 DOI: 10.3342/ceo.2015.8.1.39] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/25/2013] [Accepted: 10/01/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives Chronic rhinosinusitis (CRS) with eosinophilic mucin is relatively rare in Korea. We categorized CRS patients with characteristic eosinophilic mucin into several groups and compared the groups based on their clinicopathological features. Methods In total, 52 CRS patients with eosinophilic mucin were enrolled. Based on the presence or absence of an allergy (A) to a fungus or fungal element (F) in the mucin, the patients were divided into four groups: allergic fungal rhinosinusitis (AFRS, A+F+), AFRS-like sinusitis (A+F-), eosinophilic fungal rhinosinusitis (EFRS, A-F+), and eosinophilic mucin rhinosinusitis (EMRS, A-F-). Clinical and immunological variables were compared between the groups. Results There were 13 patients in the AFRS group, 13 in the EFRS group, and 26 in the EMRS group. No patient was assigned to the AFRS-like sinusitis group. The AFRS group showed a significantly higher association with allergic rhinitis than did the EFRS and EMRS groups. The mean total serum IgE level in the AFRS patients was significantly higher than in the EFRS and EMRS patients. While 7.7% of the patients with AFRS and EFRS were asthmatic, 65.4% of the patients with EMRS had bronchial asthma. In the AFRS and EFRS groups, 31% had bilateral disease, in contrast to 100% of EMRS patients with bilateral disease. The prevalence of high attenuation areas by computed tomography was significantly higher in the AFRS group than in the EMRS group, and the mean Hounsfield unit values of the areas of high attenuation in the AFRS patients were significantly greater than those in the EMRS patients. Conclusion AFRS is believed to be an allergic response to colonizing fungi in atopic individuals. In EFRS, local allergies to fungi may play a role in the pathogenesis of the disease. EMRS is thought to be unconnected with fungal allergies.
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Abstract
Infections of the central nervous system (CNS) are a very common worldwide health problem in childhood with significant morbidity and mortality. In children, viruses are the most common cause of CNS infections, followed by bacterial etiology, and less frequent due to mycosis and other causes. Noncomplicated meningitis is easier to recognize clinically; however, complications of meningitis such as abscesses, infarcts, venous thrombosis, or extra-axial empyemas are difficult to recognize clinically, and imaging plays a very important role on this setting. In addition, it is important to keep in mind that infectious process adjacent to the CNS such as mastoiditis can develop by contiguity in an infectious process within the CNS. We display the most common causes of meningitis and their complications.
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Evans MO, Coop CA. Novel treatment of allergic fungal sinusitis using omalizumab. ALLERGY & RHINOLOGY 2015; 5:172-4. [PMID: 25565055 PMCID: PMC4275465 DOI: 10.2500/ar.2014.5.0098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A case report of recalcitrant allergic fungal sinusitis (AFS) refractory to systemic corticosteroids and multiple functional endoscopic sinus surgeries (FESSs) treated with anti-IgE antibody omalizumab is reported. AFS is often classified with chronic rhinosinusitis (CRS). Although similar symptoms are among the two diseases, AFS has a unique pathophysiology. Patients with AFS demonstrate type 1 hypersensitivity to fungal allergens, increased total serum IgE, increased CD8+ T-cell prevalence, and IL-4 and IL-5 response. Omalizumab should be considered in the treatment of AFS.
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Affiliation(s)
- Martin Oman Evans
- Department of Internal Medicine, San Antonio Uniformed Services Health Education Consortium
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13
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Vashishth A. Extensive Allergic Fungal Rhinosinusitis: Ophthalmic and Skull Base Complications. Indian J Otolaryngol Head Neck Surg 2014; 67:227-33. [PMID: 26405655 DOI: 10.1007/s12070-014-0771-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022] Open
Abstract
To review the clinical features, ophthalmic and skull base complications, radiologic correlates, surgical methods and outcomes in cases of extensive allergic fungal rhinosinusitis (AFRS). The retrospective review was carried out at a tertiary referral center and included 11 patients with extensive AFRS. Inclusion criteria were confirmed cases of AFRS with intracranial extension, gross erosion of the skull base or medial orbital wall and/or ophthalmic complications of AFRS, including visual loss. Acute bacterial or invasive fungal sinusitis and other non-AFRS sinus pathologies with orbital or skull base complications were excluded from the study. The mean age of patients was 22.7 years. Proptosis was the most common presenting feature followed by diplopia and visual loss. Four patients exhibited unilateral visual loss with one case of sudden acute onset. Intracranial extradural spread to the middle cranial fossa was observed in two cases with cavernous sinus involvement, destruction of the entire cranial base and extension to the petrous temporal bone. Ten patients exhibited co-existing orbital and skull base erosion whereas gross erosion of the lamina papyracea alone was seen in one patient. All patients underwent endoscopic sinus surgery with complete disease clearance. The minimum and maximum follow-up periods were 1 and 3 years, respectively with one documented recurrence 18 months after surgery. Visual recovery was complete after sudden vision loss whereas it was only partial or absent in patients with prolonged vision loss. Cases of extensive AFRS with ophthalmic and skull base complications pose diagnostic and therapeutic challenges and merit early intervention with long-term follow-up.
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Affiliation(s)
- Ashish Vashishth
- Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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14
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Dasararaju R, Many WJ, Samant JS. Perplexity of a fungus in the sinus. Am J Med 2014; 127:e1-2. [PMID: 24268302 DOI: 10.1016/j.amjmed.2013.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Radhika Dasararaju
- Transfusion Medicine, The University of Alabama at Birmingham, Birmingham.
| | - Wickliffe J Many
- Infectious Disease Department, The University of Alabama at Birmingham, Montgomery
| | - Jyoti S Samant
- Infectious Disease Department, The University of Alabama at Birmingham, Montgomery
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15
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Doellman MS, Dion GR, Weitzel EK, Reyes EG. Immunotherapy in allergic fungal sinusitis: The controversy continues. A recent review of literature. ALLERGY & RHINOLOGY 2013; 4:e32-5. [PMID: 23772324 PMCID: PMC3679565 DOI: 10.2500/ar.2013.4.0045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Allergic fungal sinusitis (AFS), also referred to as allergic fungal rhinosinusitis (AFRS), is a noninvasive, eosinophilic form of recurrent chronic allergic hypertrophic rhinosinusitis. AFS has distinct clinical, histopathological, and prognostic findings that differentiate it from other forms of sinusitis. The core pathogenesis and optimum treatment strategies remain debated. Concerns surround the use of immunotherapy for AFS because allergen-specific immunoglobulin G (IgG) induced by immunotherapy could theoretically incite a Gell and Coombs type III (complex mediated) reaction. Type I hypersensitivity is established by high serum levels of allergen-specific IgE to various fungal antigens and positive Bipolaris skin test results. Type III hypersensitivity is established by an IgG-mediated process defined by the presence of allergen-specific IgG that forms complexes with fungal antigen inducing an immunologic inflammatory response. These reveal the multiple immunologic pathways through which AFS can impact host responses. Recent literature establishing benefits of fungal immunotherapy and no evidence of type III–mediated reactions, severe local reactions, or delayed reactions, indicate that application of AFS desensitization is a reasonable therapeutic strategy for this difficult to manage entity. Our review should encourage further clinical acceptance of AFS desensitization because the existing literature on this subject shows benefits of fungal immunotherapy and no evidence of type III–mediated reactions, severe local reactions, or delayed reactions.
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Affiliation(s)
- Mary S Doellman
- Department of Otolaryngology Head and Neck Surgery, San Antonio Military Medical Center, San Antonio Military Medical Center, San Antonio, Texas, and
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16
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Silva MP, Baroody FM. Allergic fungal rhinosinusitis. Ann Allergy Asthma Immunol 2013; 110:217-22. [PMID: 23535082 DOI: 10.1016/j.anai.2012.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/19/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Marianella Paz Silva
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Pritzker School of Medicine, The University of Chicago, Chicago, Illinois 60637, USA
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