Allergic fungal sinusitis (AFS) is a non-invasive form of paranasal sinus mycosis caused by the dematiaceous fungi, usually Bipolaris, Curvularia, Exserohilum, Alternaria, Drechslera, and less often by Aspergillus. We present a case of a boy with a massive paranasal polyp, from which Bipolarisspicifera was isolated. Case report: A 10-year-old immunocompetent boy, with a history of allergic rhinitis, nasal congestion, postnasal purulent discharge and restricted nasal breathing during last year, was admitted to our hospital for investigation of his symptoms. The clinical examination revealed the presence of a massive polyp which obstructed the left nostril. Chest radiography was normal. The eosinophils of the peripheral blood were not elevated. The C/T showed an extended polyp which occupied the left maxillary sinus and protruded from the maxillary sinus ostium in the left nostril. Bony erosion of the sinus walls was also apparent. Levels of fungal-specific IgE(RAST)for Cladosporiumherbarum and Alternaria alternata were elevated. The polyp was surgically removed and full histological and microbiological investigation followed. The histologic findings included inflammation of a chronic inflammatory process, presence of allergic mucin, eosinophils and lymphocytes infiltration of the mucosa, whereas Grocott's and PAS staining rendered fungal hyphae. After 72 hours' incubation, the histological specimen culture yielded a dark olive to black fungus identified as Bipolaris spicifera. Conventional identification was confirmed by sequencing (Marcogen, Seoul, Korea) of the amplified ITS1 and ITS2 regions showing 99% homology (Bioedit) with the published rRNA sequences (GenBank Acc. No AY253918). The patient, after the surgical removal of the polyp, received therapy with budesonide and desloratadine and was regularly followed up by the otolaryngology department of our hospital. Antifungal therapy was not administered Eight months after his admission to the hospital, recurrence of the disease was observed. Conclusions: Recent evidence supports the theory that AFS represents an immunologic, rather than infectious, disease process, similar to that of allergic bronchopulmonary fungal disease. Although important, surgery alone does not lead to a long-term disease-free state and plan incorporating medical, surgical and immunologic care remains the most likely means of providing long-term control of disease.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)