Sinusitis alérgica micótica / Allergic fungal sinusitis

Desde que la sinusitis alérgica micótica fue descripta inicialmente por Millar y cols. en 1981, se ha tratado de definir y explicar esta enfermedad. Ha sido comparada con la aspergilosis broncopulmonar alérgica; sin embargo, no puede ser categorizada tan fácilmente. De acuerdo con la literatura que existe hasta el momento, hay cinco criterios mayores y seis características asociadas, o criterios menores, para definir esta enfermedad. En realidad, la mayoría de los pacientes pueden presentar los cinco criterios mayores o las otras características asociadas durante los años de evolución. No sólo es difícil el diagnóstico de esta patología, sino también es complicado su manejo. Para un control efectivo de la enfermedad y evitar las recurrencias, el tratamiento incluye cirugía endoscópica de los senos y terapia médica a largo plazo; esto es: corticoides por vía oral y nasal, inmunoterapia con alergenos y antifúngicos.(AU)

Since allergic fungal sinusitis was initially described by Millar et al, in 1981, many have tried to define and explain the disorder. It has been labeled as the sinonasal equivalent of allergic bronchopulmonary aspergillosis; however, allergic fungal sinusitis cannot be categorized so easily. According to current literature, there are five major criteria and six associated characteristics, or minor criteria, of patients with allergic fungal sinusitis. This disease is not only difficult to diagnose, but one of the most complicated conditions rhinologists must manage. Endoscopic sinus surgery must be used in conjunction with long-term medical therapy, i.e., oral and nasal corticosteroids, allergen immunotherapy and antifungal therapy to effectively control the problem.(AU)

A Case of Allergic Mucin Sphenoiditis without Fungus

Allergic fungal sinusitis is characterized by eosinophilic allergic mucin with fungal hyphae in histopathologic aspect. "Allergic mucin sinusitis without fungus" or "Allergic fungal sinusitis-like syndrome" is a new term used to describe patients who have clinical and histopathologic features of allergic fungal sinusitis but fail to demonstrate fungi in histopathologic sections or cultures of sinus tissue. In this study, we report on a case of allergic mucin sinusitis which involved only sphenoid sinus of the left side in a 31 year old female.

Clinical Characteristics of Chronic Sinusitis with Allergic Mucin / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Since allergic fungal sinusitis (AFS) was first described in 1983, there have been occasional reports of patients that have typical allergic mucin without evidence of fungal disease. Clinically these patients were similar and undistinguishable from those of AFS. "Allergic mucin sinusitis without fungus" was first coined by Allphin in 1991 to describe this group of patients. The objective of this study was to evaluate the clinical features of chronic sinusitis with allergic mucin. MATERIAL AND METHOD: A review of medical records of twelve patients who had classic allergic mucin within their sinuses without documentation of the presence of fungi was undertaken. RESULTS: Eleven patients (92%) had nasal polyposis and eleven patients (92%) had one or more allergic conditions. However, only four patients (33%) had the evidence of type l hypersensitivity for fungal antigens. Postoperatively, eleven patients (92%) had recurrent symptoms and showed good response to systemic steroid therapy. In these patients, however, systemic steroid therapy was needed several times and additional surgeries were required in three patients. CONCLUSION: It remains unclear whether the chronic sinusitis of these patients is a new separate disease entity or a spectrum of the AFS. Further study will be needed to elucidate the disease entity of these patients.

A Case of Allergic Fungal Sinusitis / 대한이비인후과학회지

Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. AFS was first reported in 1983. The first case of AFS was associated with Aspergillus, but recently other fungal organisms have been implicated. AFS should be suspected in any atopic patients with refractory nasal polyps. Sinus computed tomograms and magnetic resonance imaging findings can be quite distinctive, but definite diagnosis requires histopathologic examination which shows characteristic allergic mucin. Current recommendations for therapy include conservative but complete exenteration of all allergic mucin. Adjunctive systemic steroids are often helpful. The authors present a case of allergic fungal sinusitis for the first time in Korea. The patient had nasal polyp and showed hypersitivity to fungus in RAST, elevation of total IgE, peripheral eosinophilia. On histopathologic examination, typical allergic mucin including Charcot-Leyden crystals, eosinophils and fungal hyphae were found.

Allergic Fungal Sinusitis: A Report of Two Cases

Allergic fungal sinusitis (AFS) is a benign, noninvasive form of fungal sinusitis. Histologically, AFS is characterized by allergic mucin, which consists of eosinophilic mucinous material with occasional laminar deposits of eosinophils. A diagnosis of AFS can be made when there is a demonstration of characteristic allergic mucin and an appearance of fungal hypae scattered within the mucin with no evidence of tissue invasion, or when fungi cultures yield positive results. Until now, no cases of AFS have been reported in Korea, though there have been many cases of mycetomas and a few cases of invasive fungal sinusitis. We present the first two cases of AFS in Korea. The patients demonstrated characteristic allergic mucin, fungal hypae scattered within the mucin, and no evidence of tissue invasion on histopathology. Nasal polyps, involvement of the unilateral sinuses, peripheral eosinophilia, an elevated total IgE, and hyperattenuated masses observed in the CT supported the diagnosis of AFS. The patients recovered and did not display recurrence after surgery and treatment with topical steroids and saline irrigation.