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Allergic Aspergillus flavus rhinosinusitis: a case report from Qatar
Saad J Taj-Aldeen1, Ali A Hilal, Agustin Chong-Lopez
1Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. stajaldeen@hmc.org.qa
Summary
Allergic fungal rhinosinusitis (AFS) caused by Aspergillus flavus can be serious. Prompt diagnosis via imaging and biopsy, followed by endoscopic surgery and steroids, effectively manages this fungal sinus infection.
Area of Science:
- Otolaryngology
- Mycology
- Allergy and Immunology
Background:
- Fungal rhinosinusitis presents in four forms: allergic, mycetoma, chronic invasive, and acute invasive.
- Accurate diagnosis relies on nasal endoscopy, CT imaging, tissue biopsy, and fungal culture.
- Untreated fungal rhinosinusitis poses life-threatening risks.
Observation:
- A case of allergic fungal rhinosinusitis (AFS) caused by Aspergillus flavus is detailed.
- Clinical presentation included an extensive left nasal polyp, systemic eosinophilia, elevated serum IgE, and a positive Aspergillus skin test.
- CT imaging revealed left nasal cavity and sinus opacification and expansion, with secondary right-sided inflammation.
Findings:
- Endoscopic surgery (polypectomy and ethmoidectomy) uncovered abundant allergic fungal mucin and crusts.
- Histopathology confirmed fungal hyphae in the removed mucin.
- Fungal culture identified Aspergillus flavus as the causative agent.
Implications:
- Post-operative treatment with systemic and topical steroids led to a significant decrease in serum IgE and peripheral eosinophil count.
- Combined surgical debridement and corticosteroid therapy can achieve long-term remission of allergic fungal rhinosinusitis.
- This case highlights the importance of a multidisciplinary approach for managing AFS.