Allergic fungal sinusitis: A clinicopathologic study of 16 cases

Allergic Fungal Sinusitis

“…Recognition of AM in sinus aspirates is important to clinicians because its presence implies the probable absence of invasive fungal disease. 11 With the exception of a report by Zieske et al, 12 no one has reported true fungal invasion associated with the presence of AM. 11 Although progression of AFS to a form of chronic, indolent, invasive sinusitis is theoretically possible, overdiagnosis of invasive disease, prior to publication of criteria for AFS, may have led to misconceptions.…”

“…11 With the exception of a report by Zieske et al, 12 no one has reported true fungal invasion associated with the presence of AM. 11 Although progression of AFS to a form of chronic, indolent, invasive sinusitis is theoretically possible, overdiagnosis of invasive disease, prior to publication of criteria for AFS, may have led to misconceptions. 1 Bent et al 1 think that AFS is purely an allergic disease.…”

“…6 Erosion of cranial bones, pressure-induced cranial nerve palsies and extension of mucinous exudate into the brain may result in neurologic symptoms that can be severe. 6,10,11 Alarming as these findings can be, true fungal invasion does not occur, and AFS is generally managed by surgical evacuation of AM, aeration of sinuses and oral steroid therapy. Systemic antifungal therapy is generally not indicated.…”

“…2,8 Although Katzenstein et al 4 originally assumed that AFS was associated with Aspergillus spp., in southeast and central Texas, dematiaceous fungi, especially Bipolaris spp., are most commonly isolated from patients with symptomatic AFS. 6,7,11 In AFS, typically, all or multiple paranasal sinuses are filled with a thick, greenish gold or brownblack material with the consistency of peanut butter 3,6 ; it may be foul smelling. 3 This material can be aspirated and submitted for cytologic evaluation.…”

“…Some patients are atopic. 1,3,11 Patients usually present with nasal obstruction and radiographic opacification of multiple paranasal sinuses by material with Allergic fungal sinusitis differs from invasive fungal sinusitis by the absence of bone and soft tissue invasion and absence of a history of immunosuppression....…”