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Complications of Allergic Fungal Sinusitis

  • Sarah Bozeman
    Affiliations
    Department of Medicine, Division of Clinical Allergy and Immunology, University of Mississippi Medical Center, Jackson

    Department of Pediatrics, Division of Clinical Allergy and Immunology, University of Mississippi Medical Center, Jackson
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  • Richard deShazo
    Correspondence
    Requests for reprints should be addressed to Richard deShazo, MD, Department of Medicine, Division of Clinical Allergy and Immunology, 2500 North State Street, Jackson, MS 39216-4505
    Affiliations
    Department of Medicine, Division of Clinical Allergy and Immunology, University of Mississippi Medical Center, Jackson

    Department of Pediatrics, Division of Clinical Allergy and Immunology, University of Mississippi Medical Center, Jackson
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  • Scott Stringer
    Affiliations
    Department of Otolaryngology, University of Mississippi Medical Center, Jackson
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  • Leigh Wright
    Affiliations
    Department of Medicine, Division of Clinical Allergy and Immunology, University of Mississippi Medical Center, Jackson
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      Abstract

      Purpose

      Allergic fungal sinusitis is a syndrome of chronic noninvasive fungal sinusitis that results in the accumulation of eosinophil-rich allergic mucin within the paranasal sinuses. This mucin may become an expansile mass leading to complications that have not been well characterized or classified.

      Methods

      Inclusion criteria for this study required meeting previously published diagnostic criteria and complications greater than nasal polyps or sinusitis itself. Four patients from our cohort and 30 patients identified in a literature search formed the study group.

      Results

      The majority of patients had pre-existing asthma or allergic rhinitis, or both, and 37% had nasal polyps before presentation. However, 27% had no previous history of rhinosinusitis or nasal polyposis. Complications of allergic fungal sinusitis fell into discrete categories: ophthalmic (n=13), sinobronchial allergic mycosis (n=9), bony erosion (n=8), cavernous venous thrombosis (n=3), and otic involvement (n=1).

      Conclusion

      Visual symptoms, proptosis, headaches, and increased nasal symptoms, especially in association with bony erosions on sinus computed tomography, suggest allergic fungal sinusitis and its complications in patients with chronic rhinosinusitis and nasal polyps. Patients with allergic fungal sinusitis may present with a complication of the disease as the first symptom. Complications may be categorized into groups that facilitate surveillance and early identification.

      Keywords

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