Pediatric allergic fungal rhinosinusitis with extensive intracranial extension - Case report and literature review.

INTRODUCTION: Over the last two decades, allergic fungal sinusitis (AFRS) has become increasingly common. It's defined as a noninvasive, benign inflammatory fungal disease of the sinuses which develops in young adults and adolescents. Patients often complain of symptoms like nasal obstruction, congestion, purulent or clear rhinorrhea, anosmia, and headache. The cases are also presenting clinically with symptoms like epiphora and eye discharge as a result of nasolacrimal gland obstruction. In this article, we will review a unique case of AFRS, in an adolescent male. The case was diagnosed with intracranial extradural extension. CASE REPORT: A 15 years old male with AFRS was diagnosed and managed. The case was diagnosed to have allergic fungal sinusitis based on Bent and Khun diagnostic criteria, presented with intracranial extradural extension. DISCUSSION: In our case, there were no irreversible complications except a recurrent polyp. The case was mainly complaining of long-standing nasal discharge and on-off headache with no orbital complaint and no other neurological signs. This shows a presentation of the fungal sinusitis and the need for aggressive intervention for AFRS both medically and surgically for pediatric patients as well. CONCLUSION: To conclude, despite AFRS being categorized as a benign, non-invasive disease, its presentation can range from simple nasal obstruction to signs and symptoms of intraorbital and/or intracranial complications; with pediatric cases being very aggressive. Careful clinical evaluation, detailed histopathological examination, navigation assisted endoscopic sinus surgery followed by steroid treatment, and a lifelong follow up to manage the recurrence.

Bilateral simultaneous sino-nasal inverted papilloma; A report of two cases and literature review.

INTRODUCTION: Inverted Papilloma is a benign sinonasal tumor with a high recurrence rate and potential for malignant transformation, it typically presents as an obstructing unilateral nasal mass, atypical presentations include bilateral involvement which occurs in up to 5 % of cases. CASE PRESENTATION: Here we present two different cases of bilateral inverted papilloma, both presented complaining of bilateral nasal obstruction, the second case also had associated nasal polyposis and history of multiple previous endoscopic sinus surgeries, both cases were managed with endoscopic medial maxillectomy and tumor removal, with no signs of recurrence on follow up. CONCLUSION: Bilateral involvement is an uncommon, atypical presentation of inverted papilloma, endoscopic surgery is a safe, reliable approach and it is the mainstay of treatment, regular endoscopic and clinical follow up is important for detection of recurrence.