Report of successful prolonged antifungal therapy for refractory allergic fungal sinusitis

Allergic fungal sinusitis (AFS) is an increasingly recognized cause of refractory chronic sinusitis in the young immunocompetent host, analogous to allergic bronchopulmonary aspergillosis (ABPA), a related process in the lower respiratory tract. Most patients experience remittent disease despite corticosteroid therapy and aggressive sinus surgery. Because controlled trials have shown adjunctive antifungal therapy to be of benefit in treating ABPA, long-term oral itraconazole was used in a young man with remittent AFS, which was able to break the cycle of relapsing disease.