A Case of Allergic Fungal Rhinosinusitis with Concurrently Occuring Fungus Ball

Ki Ryun Kwon; Ji Soo Park; Sung Jae Park; Ki Sang Rha; Yong Min Kim

doi:10.18787/jr.2015.22.1.47

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Kwon, Park, Park, Rha, and Kim: A Case of Allergic Fungal Rhinosinusitis with Concurrently Occuring Fungus Ball

Case Report

J Rhinol 2015;22(1):47-50.

Published online: 10 January 2015

DOI: https://doi.org/10.18787/jr.2015.22.1.47

A Case of Allergic Fungal Rhinosinusitis with Concurrently Occuring Fungus Ball

Ki Ryun Kwon, MD, Ji Soo Park, MD, Sung Jae Park, MD, Ki Sang Rha, MD, PhD, Yong Min Kim, MD, PhD

Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Chungnam National University, Daejeon, Korea

교신저자：김용민, 305-764 대전광역시 중구 문화로 266충남대학교 의학전문대학원 이비인후과학교실Tel: +82-42-280-7698, Fax: +82-42-253-405 9 E-mail: entkym@cnu.ac.kr

Received 5 January 2015 Revised 14 February 2015 Accepted 18 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Allergic fungal rhinosinusitis (AFRS) is a noninvasive fungal infection of the paranasal sinuses that are usually seen in young immunocompetent patients with atopy and/or asthma. Fungus balls can grow in moist cavities of the paranasal sinuses of a host with normal immunologic status. Cases of AFRS with concurrent fungus balls is very rare. We present a case of a patient who had AFRS on one side of the paranasal sinus and allergic fungal sinusitis on the other side. A 51-year-old female with atopy presented with a few-year history of nasal obstruction and rhinorrhea, as well as a history of high-dose systemic steroid therapy. The patient had nasal polyps and showed an elevated level of total IgE and positive MAST to fungal antigens. Endoscopic sinus surgery was performed. Allergic mucin from the right maxillary sinus contained sheets of eosinophils and Charcot-Leyden crystals. Also, a clay-like dark brown material from the left maxillary sinus was revealed to be a fungus ball.

Keywords: Mycetoma, Sinusitis, Aspergillosis.

References

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Fig. 1.

Preoperative axial (A) and coronal (B) CT scan showing total opacifi-cation of both maxillary, ethmoid sinuses with hyperattenuation in central portion of right maxillary sinus and calcification in central area of left maxillary sinus.

Fig. 2.

Thick, inspissated greenish mucoid secretion was removed from right maxillary sinus (A). Dark brown-colored clay-like material was brought out from left maxillary sinus (B).

Fig. 3.

H&E stain of right maxillary sinus lesion showing inflammatory cells composed predominantly eosinophils and Charcot-Leden crystals (A). GMS stain of right maxillary sinus lesion was positive for fungal hyphae (B). H&E stain of left maxillary sinus lesion showing aggregation of fungal hyphae, consistent with Aspergillosis (C).

Fig. 4.

Six months after surgery, endoscopic findings of polypoid mucosa with yellowish thick discharge in right sphenoethmoidal recess (A). After use of systemic steroid therapy for one week (Prednisolone 20mg per day), both yellowish discharge and polypoid lesion disappeared (B).

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