Pediatric Allergic Fungal Sinusitis with Intracranial Extension - A Case Series

This is the first report of AFS which caused frontal lobe symptomatology and which resolved with surgical therapy. The surgical approach used provided excellent exposure and the sinuses could be examined and thoroughly cleaned both from above and intranasally. The dural defect, which resulted from the destruction of the cribiform and fovea ethmoidalis, was easily reconstructed with a pericranial flap. This exposure facilitates debridement and reconstruction while minimizing complications such as cerebral spinal fluid leakage or brain injury which may occur with endoscopic manipulations in patients with bony destruction and loss of normal landmarks.

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Allergic fungal sinusitis eroding the pterygoid plates: a rare case series

Brazilian Journal of Otorhinolaryngology ◽

10.1016/j.bjorl.2014.05.028 ◽

2015 ◽

Vol 81 (1) ◽

pp. 109-112

Author(s):

Osama Marglani ◽

Ahmed Masood Shaikh

Keyword(s):

Rare Case ◽

Case Series ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis

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Allergic Fungal Sinusitis With Massive Intracranial Extension Presenting With Tearing

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/iop.0b013e3181f29c9d ◽

2011 ◽

Vol 27 (4) ◽

pp. e98-e100 ◽

Cited By ~ 5

Author(s):

Animesh Petkar ◽

Luigi Rao ◽

Daniel R. Elizondo ◽

Jeffrey Cutler ◽

Donald Taillon ◽

...

Keyword(s):

Intracranial Extension ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis

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Visual loss in the setting of allergic fungal sinusitis: pathophysiology and outcome

The Journal of Laryngology & Otology ◽

10.1017/s0022215107006226 ◽

2007 ◽

Vol 121 (11) ◽

pp. 1055-1059 ◽

Cited By ~ 9

Author(s):

A K Gupta ◽

S Bansal ◽

A Gupta ◽

N Mathur

Keyword(s):

Visual Loss ◽

Case Series ◽

Lateral Wall ◽

Contralateral Side ◽

Pathophysiological Mechanism ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Laboratory Findings ◽

Fungal Antigens ◽

Fungal Serology

AbstractObjective:To hypothesise the probable pathophysiological mechanism responsible for visual loss in allergic fungal sinusitis, other than direct compression.Design:Retrospective, non-randomised case series. Out of 274 cases of allergic fungal sinusitis, four cases with sudden visual loss were enrolled into the study. The fourth case had visual loss on the contralateral side to bony erosion of the lateral wall of the sphenoid sinus.Interventions:All four cases were evaluated with fungal smear, immunoglobulin (Ig) E titres, visual evoked potentials, non-contrast computed tomography and magnetic resonance imaging of the paranasal sinuses, and fundus examination. They then underwent endoscopic sinus debridement followed by intravenous methylprednisolone.Outcome measures:Improvement in vision.Results:All four cases experienced an improvement in vision: full recovery in three cases and partial improvement in one case.Conclusion:In view of the operative, radiological and laboratory findings for case four, with the suggestion of a hyperimmune response to fungal antigens (in the form of raised IgE titre and positive fungal serology), we suggest that a local immunological reaction to fungal antigens might be responsible for the observed visual loss in cases of allergic fungal sinusitis, in addition to mechanical compression of the optic nerve.

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Noninvasive fungal rhinosinusitis: a case series

F1000Research ◽

10.12688/f1000research.67204.1 ◽

2021 ◽

Vol 10 ◽

pp. 869

Author(s):

Mohamed Masmoudi ◽

Jihene Chelli ◽

Asma Ben Mabrouk ◽

Ezer Chebil ◽

Wadii Thabet ◽

...

Keyword(s):

Case Series ◽

University Hospital ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Management Protocol ◽

Middle Meatal Antrostomy ◽

Definition Of ◽

Histopathological Results ◽

The University

Introduction: Fungal rhinosinusitis (FRS) remains a rare disease. The noninvasive forms are hard to diagnose. The management protocols remain controversial. We aim to describe the clinical, radiological and pathological features of noninvasive FRS and present our management protocol and follow-up results. Patients and methods: This descriptive study was conducted in the ear-nose-throat department of the university hospital, Taher Sfar in Mahdia, Tunisia. All patients who responded to the definition of noninvasive FRS (fungal balls and allergic fungal sinusitis) were included. The study was conducted over a three year period (May 2017 – April 2021). Results: Eleven patients were included in this study: four cases of fungal balls and seven cases of allergic fungal sinusitis. Patients presented with symptoms of chronic recurrent rhinosinusitis with no response to conventional treatments. Computed tomodensitometry scan showed opacification of the paranasal sinuses in all patients. Other signs were heterogeneous opacities, local calcifications and thinning of the bony walls of the sinuses. Histopathological findings were inflammatory polyps in all cases of allergic FRS with the presence of fungal hyphae in 42.8% of the cases. All patients underwent surgery after a median delay of 12 [6–24] months of the symptom’s onset. The used procedures were endoscopic middle meatal antrostomy for all patients, ethmoidectomy (81.8%) and sphenoidotomy (36.4%). None received systemic antifungals or corticosteroids with a favorable outcome in all cases. Conclusion: Symptoms of noninvasive FRS are nonspecific. The scan images contribute to the diagnosis, but the perioperative findings and the histopathological results remain crucial. The management is mainly surgical.

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Allergic fungal sinusitis (AFS) – earlier diagnosis and management

The Journal of Laryngology & Otology ◽

10.1258/002221505774783412 ◽

2005 ◽

Vol 119 (11) ◽

pp. 875-881 ◽

Cited By ~ 10

Author(s):

Neeraj Singh ◽

N H Bhalodiya

Keyword(s):

Antifungal Therapy ◽

Statistical Significance ◽

Sinus Surgery ◽

Histological Evaluation ◽

Intracranial Extension ◽

Comprehensive Treatment ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Surgical Specimen ◽

Specimen Handling

Aim: To evaluate the criteria for diagnosing allergic fungal sinusitis and to maintain permanent drainage and ventilation, while preserving the integrity of mucosa. Methods: This is a prospective study of 251 patients with chronic rhinosinusitis with or without polyposis, of whom 199 were treated surgically. Mucus sample collection, nasal secretion culture, surgical specimen handling and histological evaluation of surgical specimens are described. The management included wide local endoscopic sinus debridement, adequate sinus aeration, post-operative use of steroids and antifungal therapy. Results: Fungal cultures of nasal secretions were positive in 201 (80.01 per cent) of 251 patients. Of the 199 surgical cases, fungal elements were found in 156 histological specimens (62.1 per cent). Allergic mucin was found in 182 patients (91.45 per cent). Nasal obstruction and proptosis were the commonest presentations. All pre-operative versus post-operative changes in AFS-associated complaints reached statistical significance of p < 0.001. The ethmoid sinus was commonly involved with adjacent lamina papyracea exhibiting demineralization in 26.6 per cent of cases. Intracranial extension was seen in 15 cases. Recurrence was noted in 11 cases. Conclusion: Comprehensive treatment with endoscopic sinus surgery, steroids and antifungal therapy is needed. AFS is readily recurrent. Long-term follow up is important.

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