Disclaimer: The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature.Allergic Fungal Sinusitis Case Presentation: JL is a 30-year-old man with an approximately 1-year history of nasal congestion. He began to experience headaches in a mask-like distribution episodically for several months with a small amount of greenish discharge from his nose. He denied fever, any other medical problems, and previous sinus surgery. He was given a presumptive diagnosis of acute sinustitis and treated by his primary physician with several courses of oral antibiotics. His symptoms persisted and he was referred to Otolaryngology.On physical examination, he had bilateral nasal congestion with no visible polyps. Cranial nerves II-XII were intact, his lungs were clear, and the head and neck exam was otherwise normal. CT was obtained, which revealed diffuse opacification of the sinuses consistent with polyposis.The patient was taken to the operating room for removal of nasal polyps, and on nasal endoscopy was found to have tenacious green-brown mucus with a peanut-butter like consistency. Disease was extirpated using the microdebrider and histopathology revealed allergic-appearing mucin with fungal elements. A presumptive diagnosis of Allergic Fungal Sinusitis was made. The patient was placed on nasal steroids in the post-operative period and is currently 1 month status post debridement. He is to be followed for recurrence with serial examination. Bibliography: Bent JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg 1994; 111:580-588. Chrzanowski RR, Rupp NT, Kuhn FA, Phillips AE, Dolen WK. Allergenic fungi in allergic fungal sinusitis. Ann Allergy Asthma Immunol 1997; 79:431-435. Corey JP, Romberger CF, Shaw GY. Fungal diseases of the sinuses. Otolaryngol Head Neck Surg 1990;103:1012-1015. Folker RJ, Marple BF, Mabry RL, Mabry CS. Treatment of allergic fungal sinusitis: a comparison trial of postoperative immunotherapy with specific fungal antigens. Laryngoscope 1998;108:1623-1626. Ferguson BJ. What role do systemic corticosteroids, immunotherapy, and antifungal drugs play in the therapy of allergic fungal rhinosinusitis? Arch Otolaryngol Head Neck Surg 1998;124:1174-1177. Katzenstein AA, Sale SR, Greenberger PA. Allergic aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Immunol 1983;72:89-93. Kupferberg SB, Bent JP, Kuhn FA. Prognosis for allegic fungal sinusitis. Otolaryngol Head Neck Surg 1997;117:35-41. Kuhn FA, Javer AR. Allergic fungal rhinosinusitis: our experience. Arch Otolaryngol Head Neck Surg 1998;124:1179-1180. Mabry RL. Allergy for rhinologists. Otolaryngol Clin North Am 1998;31:175-192. Mabry RL, Mabry CS. Allergic fungal rhinosinusitis: experience with immunotherapy. Arch Otolaryngol Head Neck Surg 1998;124:1178. Mabry RL, Marple BF, Folker RJ, Mabry CS. Immunotherapy for allergic fungal sinusitis: three years' experience. Otolaryngol Head Neck Surg 119:648-651. Manning SC, Holman M. Further evidence for allergic pathophysiology in allergic fungal sinusitis. Layngoscope 1998;108:1485-1496. Manning SC, Merkel M, Kriesel K, Vuitch F, Marple B. Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis. Laryngoscope 1997;107:170-176. Manning SC, Schaefer SD, Close LG, Vuitch F. Culture-positive allergic fungal sinusitis. Arch Otolaryngol Head Neck Surg 1991;117:174-178. Millar JW, Johnston A, Lamb D. Allergic aspergillus of the maxillary sinuses. Thorax 1981;36:710. Perez-Jaffe LA, Lanza DC, Loevner LA, Kennedy DW, Montone KT. In situ hybridization for penicillium in allergic fungal sinusitis. Laryngoscope 1997;107:233-239. Quraishi HA, Ramadan HH. Endoscopic treatment of allergic fungal sinusitis. Otolaryngol Head Neck Surg 1997;117:29-34. Waxman JE, Spector JG, Sale SR, Katzenstein AA. Allergic aspergillus sinusitis: concepts in diagnosis and treatment of a new clinical entity. Laryngoscope 1987;97:261-266. Zinreich SJ, Kennedy DW, Malat J, Curtin HD, Epstein JI, Huff LC, Kumar AJ, Johns ME, Rosenbaum AE. Fungal sinusitis: diagnosis with CT and MR imaging. Radiology Click here to view slides from this presentation (pdf). Grand Rounds Archive | Department Home page BCM Public | BCM Intranet | Privacy Notices | Contact BCM | BCM Site Map | ©2001-2005 Baylor College of Medicine
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