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Allergic fungal rhinosinusitis: report of 4 cases from Saudi Arabia
F A Fadl1, K M Hassan, M Faizuddin
1ENT Department, King Fahad Specialist Hospital, PO Box 2290, Buraidah, Qassim, Kingdom of Saudi Arabia.
Abstract:
Allergic fungal rhinosinusitis is a newly recognized clinical entity of chronic rhinosinusitis. Over the past 3 years, 4 such patients were treated in our hospital. The clinical and pathological features of these 4 cases which merited the criteria for such diagnosis, are described. All the 4 cases had history of nasal polyps, asthma, or both with radiographical evidence of pansinusitis. Histologically, the thick greenish-brown inspissated material specimens which were collected and submitted to the laboratory showed, eosinophils, Charcot-Leyden crystals but no fungal elements were detected on routine hematoxylin and eosin sections and no tissue invasion was noted. However, scanty aspergillus hyphae were detected on sections stained with silver. All 4 cases grew Aspergillus flavus only from the swabs and no other fungi were seen and all were treated by surgical debridement, aeration, oral itraconazole with no steroids.
Insights
Allergic fungal rhinosinusitis (AFRS) is a chronic sinus condition. Diagnosis involves identifying eosinophils and Charcot-Leyden crystals, with Aspergillus flavus confirmed via culture, guiding treatment without steroids.
Area of Science:
- Otolaryngology and Allergy
- Mycology in Clinical Diagnosis
Background:
- Allergic fungal rhinosinusitis (AFRS) is an emerging clinical diagnosis within chronic rhinosinusitis.
- This study examines four cases meeting AFRS diagnostic criteria, focusing on clinical presentation and pathology.
Observation:
- Patients presented with a history of nasal polyps, asthma, or both, alongside radiographic evidence of pansinusitis.
- Histopathology revealed eosinophils and Charcot-Leyden crystals in thick nasal discharge; routine stains showed no fungal elements or invasion.
- Silver staining identified scanty Aspergillus hyphae, and cultures exclusively grew Aspergillus flavus.
Findings:
- The findings confirm the presence of Aspergillus flavus in allergic fungal rhinosinusitis cases.
- Absence of fungal elements in H&E stains and lack of tissue invasion are noted characteristics.
- Successful treatment involved surgical debridement, aeration, and oral itraconazole, excluding steroid use.
Implications:
- This study highlights the diagnostic importance of specific stains and cultures for identifying fungi in AFRS.
- It suggests a treatment protocol for AFRS involving surgical intervention and antifungal medication, omitting corticosteroids.
- Further research into the pathogenesis and optimal management of AFRS is warranted.
