Bilateral proptosis-an unusual presentation of extensive allergic fungal sinusitis

Area of Science:

• Otolaryngology
• Ophthalmology
• Mycology

Background:

• Allergic fungal rhinosinusitis (AFRS) is the most common fungal sinusitis, often affecting atopic or immunocompetent individuals.
• It results from a hypersensitivity reaction to fungal elements, leading to rhinosinusitis symptoms and potential bony remodeling.
• Orbital involvement can cause serious complications, including visual loss.

Observation:

• This case report details a rare presentation of non-invasive AFRS with bilateral proptosis.
• The expanding mass in AFRS can lead to bony remodeling and affect adjacent structures like the orbit.
• Diagnosing AFRS involves initial radiographic imaging and confirmation via histopathological examination.

Findings:

• The patient presented with bilateral proptosis, a rare manifestation of non-invasive AFRS.
• Treatment combined endoscopic sinus surgery, steroid administration, and nasal saline irrigation.
• The management led to dramatic improvement and resolution of the bilateral proptosis.

Implications:

• This case highlights the importance of considering AFRS in patients with orbital signs and rhinosinusitis symptoms.
• Combined surgical and medical management is crucial for treating AFRS effectively.
• Endoscopic sinus surgery offers a viable and effective treatment option for complex AFRS cases with orbital involvement.