Abstract
Allergic fungal rhinosinusitis is a chronic inflammatory disorder of the sinonasal mucosa, with or without nasal polyps, which is frequently associated with microbial colonization including fungi. A case of fungal rhinosinusitis in Aseer area, Saudi Arabia, is described. The patient was admitted with common symptoms including nasal obstruction accompanied by itching, sneezing, rhinorrhea, epistaxis and recurrent headache. The patient was examined clinically and by CT scan. Nasal sinus swabs and a biopsy specimen were submitted for microbiological analysis. Polyps were surgically removed during functional endoscopic sinus surgery. Histopathology showed the presence of acute and chronic inflammatory cell infiltrates (rich in eosinophils) in the covering epithelium layers. Aspergillus flavus was isolated and identified from the lesions. The patient was discharged after showing good recovery, and home follow-up revealed no recurrences.Keywords: Paranasal sinuses, Polypoidal disease, Rhinorrhea, Fungi, Endoscopic sinus surgery
Highlights
Chronic rhinosinusitis (CRS) comprises a spectrum of diseases including fungal rhinosinusitis
Allergic fungal rhinosinusitis (AFRS) is one form which is defined as chronic inflammation of the nose and nasal sinuses, with or without nasal polyps [1]
Treatment is prescribed according to the Classification Schemes for Chronic Rhinosinusitis with Nasal Polyposis Endotypes [6], but 38–51% of CRS patients do not respond to the recommended medical therapies [6, 7]
Summary
Chronic rhinosinusitis (CRS) comprises a spectrum of diseases including fungal rhinosinusitis. Patients suffering from AFRS report nasal obstruction and secretion, olfactory impairment, head and facial pain. These symptoms impact quality of life considerably [2]. Aspergillus spp. are associated with unilateral nasal polyps and a significant recurrence rate, necessitating frequent endoscopic sinus surgery and aggressive antifungal medication. Aspergillus species was isolated from the lesions As this was a non-invasive fungal infection, no antifungal was used in this case. The fungus showed septate hyaline hyphae, conidial heads with vesicles, septate hyaline hyphae, and many spores (Fig. 3B). Such structures are characteristic of Aspergillus flavus
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