Pediatric allergic fungal rhinosinusitis with extensive intracranial extension – Case report and literature review

Alenzi, Haifa Lafi; Momen, Ali Al; Molani, Fadel

doi:10.1016/j.ijscr.2020.09.049

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…Patients with nasal polyps had a history of asthma (20%); Anatomical abnormalities such as DNS, turbinate hypertrophy, but no significant correlation with AFS Goldstein also reported a history of atopy in one third of patients and asthma in one third of AFS. As reported by Yousuf M et al, Nasal polyps were strongly associated with AFS [17][18] . Radiological assessments showed multinuclear occupation with areas of attenuation surrounded by the area of hypodensity in most of our cases.…”

Section: Discussionsupporting

confidence: 59%

Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

Zada¹,

Ahmed²,

Habib³

et al. 2021

PJMHS

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Aim: To govern the incidence of allergic fungal sinusitis in patients with nasal polyposis. Various anatomical risk factors were also investigated, including turbinate hypertrophy, deviated nasal septum and comorbidities such as asthma and diabetes. Study Design: This is a Descriptive cross-sectional study. Place and duration of study:The study was conducted at ENT Head &Neck Surgery department, Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for the duration of six months from May 2020 to October 2020. Methods: 110 patients with nasal polyps were evaluated and operated on. Samples were sent for histopathological examination and culture. All patients were assessed with clinical examination and detailed history. Laboratory tests were performed including complete blood counts, urea, electrolytes, ECG and chest radiographs for the suitability of general anesthesia as a prerequisite for surgery. In 95% of cases, computed tomography was recommended to check for sinus involvement, bone erosion, osteo-hypertrophic complex, turbinate hypertrophy, nasal septal deviation, and intracranial and intra-orbital enlargement. MRI examinations were also recommended in cases of suspected intraocular and intracranial disease (5%). Data was scrutinized on a computer using SPSS version 22.0. Results:Of the 110 patients, 65 were male and 45 were female, with a mean age of 1and ranged from 7 to 80 years. All patients had nasal polyps. The incidence of AFS was approximately 29.1% and the remaining 78 had a different pathology. Major deviation of the nasal septum and bilateral hypertrophy of the inferior turbinate’s were observed in 6 (18.7%) and 4 (12.5%) patients, respectively. Unilateral nasal polyps were observed in 7 (21.9%) patients and bilateral nasal polyps in 18 (52.3%). 19/32 (59.4%) of the cases underwent functional endoscopic surgery of the paranasal sinuses, and in 6 (18.7%) external fronto-ethmoidectomy. Two patients underwent nasal ethmoidectomy. Septoplasty and endoscopic sinus surgery were performed in a total of 3 (9.37%) cases. Key words:Allergic bronchopulmonary aspergillosis (ABPA), Allergic fungal sinusitis (AFS).

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Section: Discussionsupporting

confidence: 59%

Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

Zada¹,

Ahmed²,

Habib³

et al. 2021

PJMHS

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“…Allergic fungal rhinosinusitis (AFRS) is a noninvasive fungal sinusitis that is characterized by alterations in the innate immunity, type 2 inflammation with alteration in sino nasal adaptive immune response, and direct involvement of fungal elements in the pathogenesis [2]. Although AFRS is more commonly seen among adults, it can also occur in children, but there is a scarcity of literature on its clinical course in this age group [3]. Studies suggest that the clinical presentation of AFRS in children is subtle, with a slow onset of symptoms, and often involves facial dysmorphism [4,5].…”

Section: Discussionmentioning

confidence: 99%

Paediatric AFRS: Endoscopic Sinus Surgery: A Game Changer in Restoring Facial Cosmesis

Rethinasamy,

Penubarthi,

Paramasivam

2023

JCR

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Background: Paediatric allergic fungal rhinosinusitis is a subtype of chronic rhinosinusitis with significant focus in the paediatric population owing to early onset and difficulty managing through adult treatment options. Case Report: A 13-year-old male presented with nasal obstruction and facial deformity persisting for ten months. Examination revealed polypoidal tissue in both nasal cavities. Imaging showed involvement of all paranasal sinuses with tissue changes extending to the pons and compressing the frontal lobe. Endoscopic sinus surgery, coupled with steroids, cleared the disease. Histopathology and fungal cultures indicated allergic fungal rhinosinusitis. Post-surgery, nasal symptoms resolved, and after six months, facial deformity improved without need for further cosmetic interventions, leaving the parents satisfied. Conclusion: This case report highlights the need for early surgical intervention and monitored use of peri-operative steroids in paediatric AFRS.

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“…The current study showed no histological evidence of fungal invasion of the mucosa. Pressure atrophy due to the expansion of mucoceles and polyps is the causative factor in AFRS-related bone erosion (Alenzi et al, 2020). Allergic mucin produces inflammatory mediators, which contribute to bone erosion.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Bony Erosion in Patients With Allergic Fungal Rhinosinusitis

BHATTI

Ashraf

Irfan

2023

Biol Clin Sci Res J

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The retrospective study was conducted in Nishtar Medical Hospital & Bakhtawar Amin Hospital from January 2021 to January 2022 to evaluate CT findings of bone erosion and the implication of surgical treatment in patients with AFRS. The study was conducted on a total of 140 patients. All patients underwent sinus CT examination before the start of treatment. Experienced neuroradiologist examined CT characteristics of bone erosion. Data were recorded, including disease and bone erosion location, sinus expansion, and disease extension into neighboring anatomical spaces. Of 140 patients, 26 (18.5%) had radiographic evidence of bone erosion. 1 of the 26 patients had undergone previous endoscopic surgery. The ethmoid sinus was the most common site of bone erosion. The adjacent anatomic site which was affected most due to disease extension was the orbit. There was a significant association between bone expansion and expansion of frontal, sphenoid, ethmoid, and maxillary sinuses (P=.027). Bone erosion creates a route for disease progression in the intracranial cavity and orbit. It is not associated with fungal invasion and should be accurately differentiated from Sino nasal malignancy or invasive fungal sinusitis to avoid unnecessary invasive procedures.

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Pediatric allergic fungal rhinosinusitis with extensive intracranial extension – Case report and literature review

Cited by 6 publications

References 28 publications

Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

Study to Determine the Incidence of Allergic Fungal Sinusitis among Patients with Nasal Polyps and Its Related Risk Factors

Paediatric AFRS: Endoscopic Sinus Surgery: A Game Changer in Restoring Facial Cosmesis

Evaluation of Bony Erosion in Patients With Allergic Fungal Rhinosinusitis

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