Abstract
Allergic fungal sinusitis (AFS) often develops in unilateral paranasal sinuses, which must be differentiated from tumors. When AFS develops on both sides, however, it must be differentiated from eosinophilic chronic sinusitis with evident eosinophilic infiltration at nasal/paranasal sinus mucosa; both conditions are highly recurrent and commonly considered intractable paranasal sinusitis. Surgical correction is the primary treatment method for AFS, as it is essential to connect the paranasal sinus communication to ensure exhaustive resection of the pathologic mucosa and for nasal steroids to reach each paranasal sinus. We recently encountered two AFS cases with differing postoperative courses. Case 1 showed evident exacerbation in the computed tomography findings, which suggests progression to eosinophilic sinusitis. Case 2 showed a benign prognosis without recurrence. Close long-term follow-up should be mandatory after surgery for the treatment of AFS.
Highlights
Allergic fungal sinusitis (AFS) is a paranasal sinus disease similar to allergic bronchopulmonary aspergillosis (ABPA) that was reported for the first time in the 1980s by Millar et al [1, 2]
As for imaging characteristics, bone erosion at the orbital cavity or the bottom of the skull should be evident in computed tomography (CT) images in 20% of AFS cases [4]; we confirmed it in both cases. ese two cases satisfied all six items of the diagnostic criteria [12] put forth by the American Academy of Allergy, Asthma and Immunology (AAAAI), and we confirmed them as AFS
With no evidence of fungi or mucinous nasal mucus, a high level of blood eosinophil, evident eosinophilic infiltration in the nasal polyp tissue (>70 HPF), and dominance in CT images in both sides of the ethmoidal sinus, we diagnosed the case as eosinophilic sinusitis according to the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study [16]
Summary
Allergic fungal sinusitis (AFS) is a paranasal sinus disease similar to allergic bronchopulmonary aspergillosis (ABPA) that was reported for the first time in the 1980s by Millar et al [1, 2]. It is considered a type I or III allergic reaction to fungus at the paranasal sinus mucosa; a recent study reported that Aspergillus infiltration at the paranasal sinuses induces an atopic reaction or immune response disorder, exacerbating nasal polyps by inducing the response of T-helper 17 cells [3].
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