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Semi-invasive allergic aspergillosis of the paranasal sinuses
M F Oyarzabal1, E B Chevretton, R J Hay
1Department of Otolaryngology, Guy's Hospital, London, UK.
Abstract:
Aspergillosis of the nose and paranasal sinuses has classically been divided into four types: allergic, non-invasive, invasive and fulminant. Recent reports have suggested that a semi-invasive form with bone destruction and erosion, but without fungal tissue invasion, may occur. We present a case of allergic non-invasive aspergillosis of the paranasal sinuses with associated bone destruction extending into the orbit and anterior cranial fossa, in a non-immunocompromised patient. Surgical debridement combined with a prolonged course of oral itraconazole has resulted in long-term resolution with no evidence of recurrence of disease five years later.
Insights
Allergic non-invasive aspergillosis can cause bone destruction in immunocompromised patients. This case highlights successful surgical and antifungal treatment, demonstrating long-term resolution.
Area of Science:
- Otolaryngology
- Mycology
- Immunology
Background:
- Classically, aspergillosis of the nose and paranasal sinuses is categorized into four types: allergic, non-invasive, invasive, and fulminant.
- Recent literature suggests a potential semi-invasive form characterized by bone destruction and erosion without fungal tissue invasion.
Observation:
- A case of allergic non-invasive aspergillosis involving the paranasal sinuses is presented.
- The condition led to bone destruction extending into the orbit and anterior cranial fossa.
- The patient was non-immunocompromised.
Findings:
- Surgical debridement was performed.
- A prolonged course of oral itraconazole was administered.
- Long-term resolution with no recurrence was observed five years post-treatment.
Implications:
- This case expands the understanding of allergic non-invasive aspergillosis presentation.
- It underscores the importance of considering bone destruction in non-immunocompromised individuals with sinonasal aspergillosis.
- Successful management involves a combination of surgical intervention and targeted antifungal therapy.