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Unilateral Exserohilum Allergic Fungal Sinusitis in a Pediatric Host: Case Report
Arwa A Al Muslat1, Basmah M Alghmdi1, Abdullah J AlShehri2
1College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Introduction:
Allergic fungal sinusitis (AFS) is a result of an inflammatory reaction to fungi in the nasal and paranasal sinuses. Although the causative agents of AFS vary, Exserohilum species are among the rare ones, as only a few cases have ever been reported a few times in the literature. The objective of this report is to highlight this unusual fungal type causing unilateral AFS in Saudi Arabia.
Presentation Of The Case:
We present a case of AFS who initially presented at the age of 15 years, and was operated on in 2015 by another health care provider. He presented again in 2019 complaining of intermittent loss of smell and greenish nasal discharge, mainly from the right side for 3 months, which was associated with right-sided nasal obstruction. Based on the history and physical examination, a diagnosis of refractory chronic rhinosinusitis was made. The patient underwent functional endoscopic sinus surgery (FESS) of the paranasal sinuses and polypectomy. Histopathology of the samples taken during the surgery showed Exserohilum specie. The diagnosis of AFS was confirmed using Bent and Kuhn's criteria.
Discussion:
Allergic fungal sinusitis is believed to be an allergic reaction caused by a broad spectrum of species, the majority being Aspergillus in India and Saudi Arabia. Exserohilum species are one of the rare organisms causing AFS in our region.
Conclusion:
Most cases of AFS in our region have been reported to be caused by Aspergillus. Here we report a case of unilateral Exserohilum AFS in an immunocompetent pediatric patient.
Insights
Allergic fungal sinusitis (AFS) is an inflammatory reaction to fungi. This report highlights a rare case of unilateral AFS caused by Exserohilum species in Saudi Arabia.
Area of Science:
- Otolaryngology
- Mycology
- Immunology
Background:
- Allergic fungal sinusitis (AFS) results from an inflammatory response to fungi in the nasal passages.
- While various fungi can cause AFS, Exserohilum species are infrequently reported.
- This case highlights a rare instance of AFS caused by Exserohilum in Saudi Arabia.
Observation:
- A pediatric patient presented with recurrent unilateral symptoms including loss of smell, nasal discharge, and obstruction.
- Initial diagnosis was refractory chronic rhinosinusitis.
- Functional endoscopic sinus surgery (FESS) and polypectomy were performed.
Findings:
- Histopathology confirmed the presence of Exserohilum species.
- The diagnosis of AFS was established using Bent and Kuhn's criteria.
- This represents a rare case of unilateral AFS attributed to Exserohilum in an immunocompetent child.
Implications:
- Exserohilum species are an uncommon cause of AFS, particularly in the pediatric population.
- This case expands the known spectrum of fungal pathogens implicated in AFS.
- Highlights the importance of considering rare fungal agents in refractory sinusitis cases.
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