Allergic fungal sinusitis with extensive bone erosion of the clivus presenting with diplopia

2008 ◽  
Vol 123 (7) ◽  
pp. 817-819 ◽  
Author(s):  
S D Reitzen ◽  
R A Lebowitz ◽  
J B Jacobs
Keyword(s):  
Sphenoid Sinus ◽  
Bone Erosion ◽  
Nasal Congestion ◽  
Clinical Findings ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Anatomical Structures ◽  
History Of ◽  
Cranial Fossa ◽  
Bony Erosion

AbstractObjective:We report a case of allergic fungal sinusitis causing bone erosion and diplopia.Case report:A 43-year-old man presented with a four-month history of increased nasal congestion and progressive diplopia. Clinical examination revealed bilateral nasal polyposis and a right lateral gaze deficit, consistent with a VIth cranial nerve palsy. Computed tomography of the paranasal sinuses demonstrated a large sellar mass with extensive bony erosion and both supra- and infra-sellar extension. An endoscopic approach to the sphenoid sinus, clivus and posterior cranial fossa with image guidance was performed, enabling surgical treatment involving nasal polypectomy, wide marsupialisation of the sphenoid sinus and removal of the extensive allergic fungal mucin. The patient awoke from anaesthesia with complete resolution of his diplopia.Conclusion:Otolaryngologists should be aware that approximately 20 per cent of patients with allergic fungal sinusitis demonstrate paranasal sinus expansion and bone erosion involving surrounding anatomical structures. Such patients may have clinical findings involving the orbit and cranial vault.

Diagnosis of Allergic Fungal Sinusitis

1994 ◽  
Vol 111 (5) ◽  
pp. 580-588 ◽  
Author(s):  
John P. Bent ◽  
Frederick A. Kuhn
Keyword(s):  
Nasal Polyposis ◽  
Bone Erosion ◽  
Skin Tests ◽  
Type I ◽  
Fungal Culture ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
High Attenuation ◽  
Fungal Invasion ◽  
History Of

Allergic fungal sinusitis is a noninvasive disease first recognized approximately one decade ago. It accounts for approximately 6% to 8% of all chronic sinusitis requiring surgical intervention and has become a subject of increasing interest to otolaryngologists and related specialists. Although certain signs and symptoms, as well as radiographic, intraoperative, and pathologic findings, may cause the physician to suspect allergic fungal sinusitis, no standards have been defined for establishing the diagnosis. It is extremely important to recognize allergic fungal sinusitis and differentiate it from chronic bacterial sinusitis and other forms of fungal sinusitis because the treatments and prognoses for these disorders vary significantly. To delineate a set of diagnostic criteria, we prospectively evaluated our most recent 15 patients with allergic fungal sinusitis. An allergy evaluation confirmed atopy through a strong history of inhalant mold allergies, an elevated total immunoglobulin E level, or a positive result of a skin test or radioallergosorbent test to fungal antigens in 100% of patients. All 15 patients had nasal polyposis, and 8 of 15 had asthma. There was a unilateral predominance in 13 of 15 cases. A characteristic computerized tomography finding of serpiginous areas of high attenuation in affected sinuses was seen in all patients, and 12 of 15 patients had some degree of radiographic bone erosion. Pathologic examination uniformly revealed eosinophilic mucus without fungal invasion into soft tissue; Charcot-Leyden crystals and peripheral eosinophilic were each observed in 6 of 15 patients. Every patient had fungus identified on fungal smear, although only 11 of 15 fungal cultures were positive. Therefore, for the diagnosis of allergic fungal sinusitis to be established, the following criteria should be met: (1) type I hypersensitivity confirmed by history, skin tests, or serology; (2) nasal polyposis; (3) characteristic computed tomography signs; (4) eosinophilic mucus without fungal invasion into sinus tissue; and (5) positive fungal stain of sinus contents removed during surgery. Radiographic bone erosion does not necessarily imply invasive disease, and a positive fungal culture, although desirable, is not necessary to confirm the diagnosis. Unilateral predominance of disease, a history of asthma, Charcot-Leyden crystals, and peripheral eosinophilla corroborate the diagnosis but are not always present. Perhaps because of the novelty of the disease, much misunderstanding surrounds allergic fungal sinusitis. Misdiagnosis is common, recurrence rates are high, and proper treatment remains elusive. Before proceeding with other advances, a common understanding of the diagnosis of allergic fungal sinusitis is mandatory.

Ethnic and Gender Differences in Bone Erosion in Allergic Fungal Sinusitis

2004 ◽  
Vol 18 (6) ◽  
pp. 397-404 ◽  
Author(s):  
Sarah K. Wise ◽  
Giridhar Venkatraman ◽  
Justin C. Wise ◽  
John M. DelGaudio
Keyword(s):  
Gender Differences ◽  
Bone Erosion ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
And Gender

scholarly journals Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

2021 ◽  
Vol 15 (7) ◽  
pp. 1860-1863
Author(s):  
Bakht Zada ◽  
Ejaz Ahmed ◽  
Muhammad Habib ◽  
Zafar Iqbal ◽  
Rehan Saleem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nasal Septum ◽  
Nasal Polyps ◽  
Bone Erosion ◽  
Histopathological Examination ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Deviated Nasal Septum ◽  
Allergic Fungal Sinusitis ◽  
Turbinate Hypertrophy

Aim: To govern the incidence of allergic fungal sinusitis in patients with nasal polyposis. Various anatomical risk factors were also investigated, including turbinate hypertrophy, deviated nasal septum and comorbidities such as asthma and diabetes. Study Design: This is a Descriptive cross-sectional study. Place and duration of study:The study was conducted at ENT Head &Neck Surgery department, Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for the duration of six months from May 2020 to October 2020. Methods: 110 patients with nasal polyps were evaluated and operated on. Samples were sent for histopathological examination and culture. All patients were assessed with clinical examination and detailed history. Laboratory tests were performed including complete blood counts, urea, electrolytes, ECG and chest radiographs for the suitability of general anesthesia as a prerequisite for surgery. In 95% of cases, computed tomography was recommended to check for sinus involvement, bone erosion, osteo-hypertrophic complex, turbinate hypertrophy, nasal septal deviation, and intracranial and intra-orbital enlargement. MRI examinations were also recommended in cases of suspected intraocular and intracranial disease (5%). Data was scrutinized on a computer using SPSS version 22.0. Results:Of the 110 patients, 65 were male and 45 were female, with a mean age of 1and ranged from 7 to 80 years. All patients had nasal polyps. The incidence of AFS was approximately 29.1% and the remaining 78 had a different pathology. Major deviation of the nasal septum and bilateral hypertrophy of the inferior turbinate’s were observed in 6 (18.7%) and 4 (12.5%) patients, respectively. Unilateral nasal polyps were observed in 7 (21.9%) patients and bilateral nasal polyps in 18 (52.3%). 19/32 (59.4%) of the cases underwent functional endoscopic surgery of the paranasal sinuses, and in 6 (18.7%) external fronto-ethmoidectomy. Two patients underwent nasal ethmoidectomy. Septoplasty and endoscopic sinus surgery were performed in a total of 3 (9.37%) cases. Key words:Allergic bronchopulmonary aspergillosis (ABPA), Allergic fungal sinusitis (AFS).

scholarly journals 714. Invasive Fungal Infection Caused by Curvularia Species in a Patient with Intranasal Drug Use: A Case Report

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S456-S457
Author(s):  
Bakri Kulla ◽  
Jason Pham ◽  
McKenna Johnson
Keyword(s):  
Case Report ◽  
Head And Neck ◽  
Mental Status ◽  
Sphenoid Sinus ◽  
Altered Mental Status ◽  
The United States ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
History Of ◽  
Curvularia Species

Abstract Background Invasive fungal infections (IFIs) are uncommon infections that account for approximately 27.2/100,000 cases per year in the United States. One form of IFI is chronic invasive fungal sinusitis (CIFS). If untreated, invasion into neighboring structures may cause altered mental status, seizures, strokes, proptosis, and intracranial complications. Case Report An afebrile 43-year-old female with a history of polysubstance abuse presented to the ED due to altered mental status, left sided facial droop, right sided hemiparesis, and slurred speech. The patient was somnolent but arousable to stimuli and appeared acutely ill. The patient’s mother reported a history of cocaine abuse, which was confirmed on urine toxicology. A CT head and neck with contrast revealed subacute basal ganglia lacunar infarcts and a left sphenoid opacity with scattered hyperintensities and erosive changes [Figure 2]. One month prior, she had been diagnosed with a left superior pole kidney mass and a left-sided enlarged periaortic lymph node containing multiple noncaseating granulomas and GMS stains positive for fungal hyphae [Figure 1]. The patient underwent nasal endoscopy with tissue biopsy. Tissue showed necrotizing invasive fungal sinusitis with granuloma formation and foreign-body giant cell reaction. Fungal speciation of the tissue culture showed Curvularia species was placed on IV voriconazole. While the infection stabilized, her neurologic deficits did not significantly improve. She was discharged to inpatient rehabilitation. Figure 1. Coronal and axial view of left upper pole kidney mass with perinephric fat stranding. Figure 2. MRI brain CTA Head and Neck with contrast in axial plane showing multifocal infarcts likely represent complications of fungal basilar meningitis secondary to the left sphenoid sinus disease. Imaging also shows irregular erosive change at the anterior aspect of the sella turcica, through the planum sphenoidale, and bony defect of the sphenoid sinus. Methods Results Conclusion Intranasal use of cocaine causes vasoconstriction to elicit sinonasal tissue ischemia. With extended use, chronic mucosal inflammation can occur that can result in sinonasal osteocartilaginous necrosis and potential for infection. CIFS is infrequently diagnosed and its indolent nature with progression over weeks or months can make diagnosis and treatment difficult. The most frequent fungal species identified are the Aspergillus species, but Curvularia species have been found as well. CT and MRI scanning can be suggestive, but are not sufficiently specific or sensitive. The main forms of interventional modalities include surgical debridement and antifungal therapy to maximize survival Disclosures All Authors: No reported disclosures

scholarly journals A RADIOLOGICAL PROFILE OF FUNGAL SINUSITIS

2017 ◽  
Vol 10 (9) ◽  
pp. 331
Author(s):  
Suresh Pillai ◽  
Ajay M Bhandarkar ◽  
Suraj S Nair ◽  
Anusha Taarinie Jha ◽  
Balakrishnan Ramaswamy ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Bone Erosion ◽  
Laboratory Evaluation ◽  
Fungal Sinusitis ◽  
Fluid Level ◽  
Chi Square ◽  
Single Blind ◽  
Bony Erosion ◽  
Control Study ◽  
Chronic Invasive

  Objectives: To create a radiological profile of fungal sinusitis and determine the radiological differences between fungal and nonfungal sinusitis based on the presence of hyperattenuation, bony erosion, neo-osteogenesis, air-fluid level, and extrasinus extension.Methods: This is a retrospective, single-blind, case-control study involving the analysis of 119 computed tomography (CT) scans of the paranasal sinuses. Based on the histopathology, they were divided into cases comprising fungal sinusitis and controls of nonfungal sinusitis. Benign and malignant tumors and previously operated cases of fungal sinusitis were excluded from the study. The principal investigators were blinded to the diagnosis. The comparison parameters were hyperattenuation, the presence of air-fluid level, bone erosion, neo-osteogenesis, and extrasinus extension. Data was analyzed by Chi-square and Fischer exact t-test using SPSS 14.0 software and a p < 0.05 was considered significant.Results: Our study showed the presence of hyperattenuation, neo-osteogenesis, bone erosion, air-fluid level, extrasinus extension in 75.2%, 48.3%, 25.9%, 36.2%, and 6.9% of the cases and 13.1%, 16.4%, 6.6%, 9.8%, and 0 controls, respectively. All the parameters were statistically significant in cases when compared to controls.Conclusion: Hyperattenuation, neo-osteogenesis, air-fluid level, bone erosion, and extrasinus extension are the parameters on CT imaging that will help routinely assess and differentiate fungal sinusitis from nonfungal sinusitis with considerable accuracy, although, there is an overlap with malignancy when the parameter of bone erosion is considered as a differential diagnosis of chronic invasive fungal sinusitis. It reiterates the fact that history, clinical examination, and laboratory evaluation hold an important role in provisional diagnosis.

Bony Erosion Patterns in Patients with Allergic Fungal Sinusitis

2015 ◽  
Vol 29 (4) ◽  
pp. 243-245 ◽  
Author(s):  
Lauren C. White ◽  
David W. Jang ◽  
Joshua C. Yelvertan ◽  
Stilianos E. Kountakis
Keyword(s):  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Bony Erosion

Allergic Mucin Sinusitis without Fungus

1997 ◽  
Vol 11 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Hassan H. Ramadan ◽  
Huma A. Quraishi
Keyword(s):  
Clinical Picture ◽  
Nasal Polyposis ◽  
Clinical Presentation ◽  
Fungal Sinusitis ◽  
Asthma Treatment ◽  
Allergic Fungal Sinusitis ◽  
Fungal Hyphae ◽  
History Of ◽  
Allergic Mucin

Allergic fungal sinusitis (AFS) is a distinct clinical pathologic entity that has been recognized for over a decade. The hallmark of this process is eosinophilic allergic mucin with fungal hyphae on histopathology. We have identified a subset of patients who present with a clinical picture similar to that of AFS patients in which fungus could not be demonstrated pathologically or on culture. We present four cases of allergic mucin sinusitis without fungus. A comparison of the clinical presentation of this group of patients with those with AFS will be discussed. Both groups had nasal polyposis and a history of multiple sinonasal procedures. By contrast, the patients with allergic mucin sinusitis were older than the AFS group. All of the patients with allergic mucin sinusitis also had asthma. Treatment was the same for both groups of patients.

scholarly journals A rare presentation of orbital complication of invasive fungal sinusitis in an immunocompetent young boy-a rare case

2012 ◽  
Vol 8 (1) ◽  
pp. 48-51
Author(s):  
S Gaur ◽  
A Lavania ◽  
R Saxena
Keyword(s):  
Eye Movements ◽  
Maxillary Sinus ◽  
Young Male ◽  
Medial Wall ◽  
Fungal Sinusitis ◽  
Rare Presentation ◽  
Allergic Fungal Sinusitis ◽  
Surgery Patient ◽  
History Of ◽  
Ethmoid Sinuses

We present a case of allergic fungal sinusitis (AFS) in a 24 -year old man with history of left sided nasal obstruction and discharge since few years. Since few months he developed epiphora in the left eye associated with discomfort on eye movements. Patient was examined and CT with contrast was done. CT contrast showed an enhancing lesion in Left maxillary and ethmoid sinuses and erosion of the inferior bony wall of the orbit and medial wall of maxillary sinus. Though most patients of fungal sinusitis are immunocompromised but this patient was young male immunocompetent and made an unusual presentation with visual epiphora and painful eye movements. CT showed bony erosion of the Left inferior Bony wall of the Orbit and medial wall of Maxillary Sinus. After through examination and specific investigations, the patient was posted for surgery. We planed for Cald well –Luc’s Surgery and Endoscopic excision of the mass .Histological examination was reported as non malignant and microscopy showed Fungal Hyphae. After the surgery patient was discharged satisfactorily within couple of days and followed up regularly. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 48-51 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6826

scholarly journals A Comparison of Sphenoid Sinus Osteoneogenesis in Aspirin-Exacerbated Respiratory Disease

2020 ◽  
pp. 194589242094173
Author(s):  
Madison J. Malfitano ◽  
Griffin D. Santarelli ◽  
Mark Gelpi ◽  
William C. Brown ◽  
Wesley H. Stepp ◽  
...  
Keyword(s):  
Respiratory Disease ◽  
Sphenoid Sinus ◽  
Ct Scans ◽  
Fungal Sinusitis ◽  
Bone Thickness ◽  
Allergic Fungal Sinusitis ◽  
Pronounced Difference ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Bone Changes ◽  
Left And Right

Background Aspirin-exacerbated respiratory disease (AERD) is characterized by excessive leukotriene production, diffuse polyp burden and osteitic bone changes. These bony changes have not been previously characterized. Objective The aim of this radiographic study is to characterize the bony changes noted on computed tomography (CT) scans of the sphenoid sinus in patients with AERD compared to other diseased sinonasal inflammatory states and non-diseased controls. Methods A retrospective review of 43 patients with clinically confirmed AERD were included and compared to 22 non-diseased, 9 allergic fungal sinusitis, and 43 chronic rhinosinusitis controls (23 without polyps and 18 with polyps). Comparative measurements were performed using fine-cut CT scans. Sites of comparison were the intersinus septum, the left and right lateral sphenoid wall, the roof, and left and right floor of the sphenoid sinus. Standardized measurements were averaged by two separate rhinologists. Results Patients with AERD had an average statistically significant increase in bone thickness compared to healthy and diseased controls in nearly every site with the most pronounced changes in the intersinus septum (p < 0.05). Conclusion Patients with AERD have significantly increased thickness of the sphenoid bone compared to control groups with the most pronounced difference in the intersinus septum. These findings may help clinicians increase suspicion for a diagnosis of AERD who clinically have diffuse nasal polyposis.

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