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Alhussien A, Alghulikah A, Albaharna H, Alserhani A. Loss of Vision Outcome for Allergic Fungal Sinusitis: Case Report and Literature Review. THERAPEUTIC ADVANCES IN ALLERGY AND RHINOLOGY 2023; 14:27534030231176774. [PMID: 37313392 PMCID: PMC10259143 DOI: 10.1177/27534030231176774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/03/2023] [Indexed: 06/15/2023]
Abstract
Visual loss is a rare manifestation of allergic fungal rhinosinusitis (AFRS). We report a case of an adult male who was diagnosed with AFRS and who presented during the COVID-19 pandemic lockdown with sudden-onset complete vision loss and a lack of recovery after surgical and medical management. We reviewed the literature on reported cases of AFRS complicated by visual loss to identify factors associated with visual outcomes. We found 50 patients who were diagnosed with acute visual loss due to AFRS, with an average age of 28 ± 14 years. Complete and partial recovery after surgical intervention were reported in 17 and 10 cases, respectively. However, the absence of vision improvement was reported in 14 of the cases. Early diagnosis and prompt intervention can return vision back to normal. However, delayed presentation, complete loss of vision, and acute onset of visual loss are associated with worse outcomes.
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Affiliation(s)
- Ahmed Alhussien
- Otolaryngology - Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Alghulikah
- Otolaryngology - Head & Neck Surgery Unit, Surgery Department, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Hussain Albaharna
- Otolaryngology ‐ Head and Neck Surgery Department, Qatif Central Hospital, Qatif City, Saudi Arabia
| | - Abdulrahman Alserhani
- Otolaryngology ‐ Head and Neck Surgery Department, Ad Diriyah Hospital, Riyadh, Saudi Arabia
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2
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AlAhmari AA. Allergic Fungal Rhinosinusitis in Saudi Arabia: A Review of Recent Literature. Cureus 2021; 13:e20683. [PMID: 35106223 PMCID: PMC8785804 DOI: 10.7759/cureus.20683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/12/2022] Open
Abstract
Allergic fungal rhinosinusitis (AFRS) has been considered an enigma since it was first described four decades ago. Previous research has found that AFRS has multiple definitions and a poorly understood pathogenesis because it overlaps with other conditions and necessitates meticulous work and multiple diagnostic modalities to confirm the diagnosis. However, despite the expansion of medical and surgical treatments, recurrence still occurs. In this review, the recent literature on AFRS cases in Saudi Arabia with relevance to its epidemiology, diagnosis, and management was studied and compared with international data. PubMed, Google Scholar, and Cochrane Library were searched for original research and review articles with local data. There is an evident paucity and contradiction between local studies regarding the epidemiology, diagnostic methods, and management of AFRS. Hence, well-defined randomized controlled trials (RCTs) are needed for the treatment of this chronic recurrent disease.
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Yvon C, Abdulla D, Watson S, Bagwan I, Mclean C. Frontal sinus infection leading to sino-orbital aspergillosis: a case report. Pan Afr Med J 2021; 40:95. [PMID: 34909083 PMCID: PMC8607949 DOI: 10.11604/pamj.2021.40.95.28261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 10/03/2021] [Indexed: 11/11/2022] Open
Abstract
Sino-orbital aspergillosis is an uncommon but aggressive infection. It rarely originates from the frontal sinus due to the complex anatomy of the frontal recess and anteromedial position of its ostium. An 87-year-old man of Nigerian heritage with a history of multiple myeloma, chronic kidney disease and type 2 diabetes, presented to the eye clinic with a right tense swollen eyelid and proptosis. Computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed a right superomedial mass communicating with the frontal sinus and biopsy confirmed an orbital aspergilloma. The patient was successfully treated with debulking surgery and anti-fungal treatment despite developing side effects to the drugs. To improve prognosis, ophthalmologists should be aware of this distinct entity and use a multi-disciplinary approach.
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Affiliation(s)
- Camille Yvon
- Royal Surrey County Hospital, Guildford, United Kingdom
| | - Didar Abdulla
- Royal Surrey County Hospital, Guildford, United Kingdom
| | - Sarah Watson
- Royal Surrey County Hospital, Guildford, United Kingdom
| | - Izhar Bagwan
- Royal Surrey County Hospital, Guildford, United Kingdom
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Casula E, Letizia Manca M, Manconi M. An integrative review on the uses of plant-derived bioactives formulated in conventional and innovative dosage forms for the local treatment of damaged nasal cavity. Int J Pharm 2021; 610:121229. [PMID: 34715259 DOI: 10.1016/j.ijpharm.2021.121229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/09/2021] [Accepted: 10/21/2021] [Indexed: 12/22/2022]
Abstract
Plants and their derivates have been used as medicines for centuries and today is being re-discovered their usefulness for the human health. The therapeutic properties of phytochemicals are re-evaluated under the light of medical and pharmacological research, pushed by a constantly growing market demand, where consumers trust more natural products than synthetic drugs. New studies are enlightening the effectiveness of phytochemicals against a wide range of ailments, nevertheless very few evaluate the efficacy of topical formulations based on natural bioactive molecules in the treatment of nasal mucosal diseases. This review aims at exploring this little covered topic. An overview on the properties and functionality of the nasal mucosa and the different diseases affecting it has been provided. We summarized various nasal dosage forms containing natural bioactive and explored how innovative delivery systems loading phytochemicals can improve the treatment results. Finally, the potential use of novel nanocarriers for the treatment of nasal ailments has been covered as well.
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Affiliation(s)
- Eleonora Casula
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy
| | - Maria Letizia Manca
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy.
| | - Maria Manconi
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, Via Ospedale 72, 09124 Cagliari, Italy
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Dryden SC, Evans WI, Percelay PJ, Johnson SA, Hoehn ME. Allergic Fungal Sinusitis: Ophthalmic Complications Due to the COVID-19 Pandemic and the Potential of Telemedicine. Cureus 2021; 13:e16458. [PMID: 34422487 PMCID: PMC8370570 DOI: 10.7759/cureus.16458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 11/29/2022] Open
Abstract
We report a case of a 26-year-old female who initially presented to an outside optometrist with complaints of proptosis and decreased visual acuity. Magnetic resonance imaging (MRI) obtained at that time was concerning for allergic fungal sinusitis. Unfortunately, the patient’s referral to ophthalmology was delayed due to the coronavirus disease 2019 (COVID-19) pandemic. On presentation to ophthalmology one year later, the patient had clinically deteriorated with significant visual and olfactory loss. She underwent emergent endoscopic sinus surgery by otolaryngology with histological analysis of the sinus debris confirming allergic fungal sinusitis. This is a unique case demonstrating the devastating impact that the COVID-19 pandemic had on patient care for an otherwise treatable condition. We propose the utilization of telemedicine networks as a way to prevent similar complications.
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Affiliation(s)
- Stephen C Dryden
- Ophthalmology, The University of Tennessee Health Science Center, Memphis, USA
| | - William I Evans
- Ophthalmology, The University of Tennessee Health Science Center, Memphis, USA
| | - Paul J Percelay
- Ophthalmology, The University of Tennessee Health Science Center, Memphis, USA
| | - Simon A Johnson
- Ophthalmology, The University of Tennessee Health Science Center, Memphis, USA
| | - Mary E Hoehn
- Ophthalmology, The University of Tennessee Health Science Center, Memphis, USA
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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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Woakes Syndrome: A Rare Cause of Proptosis due to Sinonasal Polyposis. Ophthalmic Plast Reconstr Surg 2019; 35:e102-e104. [PMID: 31283698 DOI: 10.1097/iop.0000000000001427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors report 2 consecutive adult male patients, aged 61 and 38 years, who presented with painless unilateral proptosis. Their past medical histories were negative for asthma, allergies, and Graves disease. On examination, the nose bridge of the eldest patient was clearly enlarged. Computed tomography scans of the orbits and paranasal sinuses showed in both patients the same radiologic pattern of hyperdense ethmoidal opacifications and expansion of the inferomedial orbital floor. Histopathological analysis of the ethmoidal cells mucosa obtained during inferomedial decompression revealed benign sinonasal polyposis. These cases demonstrate that asymptomatic sinonasal polyposis can be a rare cause of proptosis.
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Lee AS, Lee PWY, Allworth A, Smith T, Sullivan TJ. Orbital mycoses in an adult subtropical population. Eye (Lond) 2019; 34:1640-1647. [PMID: 31822858 PMCID: PMC7608426 DOI: 10.1038/s41433-019-0733-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/28/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
Background/objectives To report the spectrum of fungal infections involving the orbit encountered in an Australian subtropical population with respect to presentation, host risk factors, involved pathogens, treatment and outcomes. Subjects/methods A retrospective chart review was performed on all adult patients with orbital mycosis treated by the senior author (TJS) from 1986 to 2017 in a tertiary setting. Results Thirty cases of fungal infection involving the orbit were included in this case series. Of these, 26 patients had invasive disease and four patients had non-invasive disease. Causative organisms included mucormycosis (16), aspergillus (8) and other fungi (7). Common risk factors included haematological disorders or malignancy, neutropenia, corticosteroid use and diabetes mellitus. Mucormycosis in three immunocompetent patients was caused by Apophysomyces elegans. Orbital apex syndrome was observed in approximately one third of patients at initial ophthalmological assessment. Amphotericin B was used in most cases of mucormycosis, while there was a more varied spectrum of anti-fungal use in other fungal infections. Seven patients with mucormycosis proceeded to orbital exenteration with a survival rate of 43%. No patients with other orbital fungal infections were exenterated. Conclusions Orbital mycoses are not only opportunistic but true pathogenic infections. While initial symptoms may be varied, the development of orbital apex syndrome should raise suspicion for this condition, regardless of patient immune status or age. Survival and visual outcomes are often poor with invasive disease. Multidisciplinary team management with early orbital specialist involvement is essential.
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Affiliation(s)
- Allister S Lee
- Department of Ophthalmology, Royal Brisbane and Women's Hospital (RBWH), Brisbane, QLD, Australia. .,University of Queensland, Brisbane, QLD, Australia.
| | - Princeton W Y Lee
- Department of Ophthalmology, Royal Brisbane and Women's Hospital (RBWH), Brisbane, QLD, Australia
| | - Anthony Allworth
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Tai Smith
- Queensland Eye Institute, Brisbane, Australia
| | - Timothy J Sullivan
- Department of Ophthalmology, Royal Brisbane and Women's Hospital (RBWH), Brisbane, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
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Abstract
BACKGROUND Allergic fungal rhinosinusitis (AFRS) is a common condition in which sinusitis develops as an IgE-mediated response to common sinonasal fungal organisms. If that response leads to blockage of sinus ostia, bone expansion and erosion by expansive cysts containing dense inspissated debris may occur with the potential for critical neurovascular compression including damage to the anterior visual pathway. METHODS Review of clinical and imaging features of 2 patients who sustained catastrophic clinical outcomes. RESULTS The first patient had pansinusitis with massive mucocele-like cysts expanding the sphenoid sinus and cranial base and causing compression of the anterior visual pathway that led to persistent severe vision loss despite extensive sinus surgery. The second patient developed sphenoethmoidal expansion with a marked inflammatory response and presumed conversion to invasive fungal sinusitis that caused anterior visual pathway vision loss, bilateral ocular motor palsies from extension into the cavernous sinuses, and death from a large middle cerebral artery stroke. CONCLUSIONS Although AFRS is most often benign and treatable, it may rarely produce catastrophic outcomes, especially if the sphenoid sinus is involved. Irreversible vision loss may occur from compression, and ocular motor palsies and death from conversion to invasive fungal disease. Close ophthalmologic and imaging monitoring is necessary in patients with expanded sinuses, and prophylactic sinus surgery may be indicated in certain cases.
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Lee A, Ellul D, Sommerville J, Earnshaw J, Sullivan TJ. Bony orbital changes in allergic fungal sinusitis are reversible after treatment. Orbit 2019; 39:45-47. [PMID: 31169421 DOI: 10.1080/01676830.2019.1576740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Allergic fungal sinusitis (AFS) arises from a host hypersensitivity reaction to fungi residing within the sino-nasal tract. Computed tomography imaging may show heterogenous sinus opacification with bony erosion and expansion into the orbits. With advanced orbital involvement there is a risk of optic neuropathy and irreversible vision loss. We present a patient with AFS who presented with bilateral proptosis and early optic neuropathy. Radiologically, there was evidence of bony erosion and orbital wall compression. Following oral corticosteroids and full-house endoscopic sinus surgery, these changes reversed considerably. This case shows that bony and anatomical orbital changes from AFS are reversible with adequate surgical treatment.
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Affiliation(s)
- Allister Lee
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Otolaryngology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David Ellul
- Department of Otolaryngology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jennifer Sommerville
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - James Earnshaw
- Department of Otolaryngology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Timothy J Sullivan
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
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Halliday L, Curragh D, Selva D. A rare case of invasive sino-orbital aspergillosis arising from isolated frontal sinus infection. Can J Ophthalmol 2018; 54:e19-e21. [PMID: 30851789 DOI: 10.1016/j.jcjo.2018.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Luke Halliday
- University of Adelaide, Adelaide, Australia; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia.
| | - David Curragh
- University of Adelaide, Adelaide, Australia; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
| | - Dinesh Selva
- University of Adelaide, Adelaide, Australia; South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, Australia
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