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[Allergic fungal rhinosinusitis: A diagnosis to evoke]

Lucy Di Marco1, Kevin Pujo2, Damien Molly3

  • 1Radiologie neuro-ORL et ostéo-articulaire, hôpital Edouard-Herriot, pavillon B, 5, place d'Arsonval, 69437 Lyon cedex 03, France.

Presse Medicale (Paris, France : 1983)
|July 26, 2018
PubMed

Insights

Allergic fungal rhinosinusitis is a rare fungal infection diagnosed using clinical, pathological, biological, and radiological criteria. Early diagnosis and differentiation from other fungal infections are crucial for appropriate treatment and prognosis.

Area of Science:

  • Otolaryngology
  • Mycology
  • Immunology

Background:

  • Allergic fungal rhinosinusitis (AFRS) is a distinct fungal infection of the nasal sinuses.
  • It is characterized by an allergic response to fungi in immunocompetent individuals, often presenting with nasal polyposis.

Purpose of the Study:

  • To outline the diagnostic criteria for allergic fungal rhinosinusitis.
  • To emphasize the importance of differentiating AFRS from other fungal sinonasal infections.

Main Methods:

  • Diagnosis relies on a combination of clinical, pathological, biological, and radiological findings.
  • Clinical criteria include presentation in young, immunocompetent patients with bilateral nasosinusal polyposis.
  • Pathological criteria involve allergic mucin with fungal hyphae and eosinophilic mucus without tissue invasion.
  • Biological criteria include hypereosinophilia and specific antifungal IgE.
  • Radiological assessment utilizes CT (tomodensitometry) and MRI to identify characteristic sinonasal cavity changes.

Main Results:

  • Diagnostic criteria encompass clinical presentation, pathological findings (allergic mucin, fungal hyphae), biological markers (hypereosinophilia, IgE), and specific radiological features.
  • CT scans show heterogeneous hyperdense filling with expanded bony walls.
  • MRI reveals extensive lesions with characteristic signal intensities (hypo- and as-signal T1/T2) and a cerebriform appearance.

Conclusions:

  • Allergic fungal rhinosinusitis requires a multidisciplinary diagnostic approach.
  • Accurate differentiation from other fungal sinonasal infections is essential due to differing prognoses and treatment strategies.

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