Allergic aspergillus sinusitis with proptosis

Abstract

Allergic aspergillus sinusitis has recently been increasingly recognized. Five cases are discussed. All presented with proptosis, signs and symptoms of allergic rhinitis and radiological evidence of expansile masses with calcification and bony erosions involving multiple sinuses. Greenish cheesy material was seen at surgery. Histologically the lesions contained eosinophils, Charcot-Lyden crystals and fungal septate hyphae. Aspergillus fumigatus was grown from all cases. Surgical removal with drainage and aeration were performed. The follow-up period ranged between three to 18 months. Recurrence occurred in one patient.Allergic aspergillus sinusitis can mimic malignant disease and should be considered in the differential diagnosis of lesions involving multiple sinuses. It should also be considered in all cases of proptosis.

Sinus Aspergillosis and Allergic Fungal Sinusitis

“…Sinus expansion with bony erosion may be present. 2,3,5,6,9,14 All of our patients but two (nos. 4 and 8) fit these criteria.…”

“…2,6,10,13 Because of the histopathological similarity to mucoid impaction of the bronchi seen in allergic bronchopulmonary aspergillosis, Aspergillus species were initially suspected as the causative agent, and thus the name of allergic aspergillus sinusitis (ASS) was used in the literature.…”

“…2,5,9 Preoperative CT scan determines the extent of the lesion and accordingly helps in the choice of surgical approach. 2,3,7,9,12,15 However, the recommended approaches vary according to the surgeon's experience and preference. Stammberger 4 advocated the use of endoscopic sinus surgery (ESS) for all cases, whereas Kennedy 15 recommended the use of ESS for limited cases without extra sinus extension.…”

“…8,9 Recently, several reports about fungal sinusitis from Saudi Arabia were published. 2,9 We present our experience in the management of 14 patients with fungal sinusitis in Ohud Hospital, Madinah, Saudi Arabia.…”

Aspergillus Sinusitis: A Radiologic Study

“…Expansion into the orbit was seen in one patient. 9 On the other hand, patients with PPAG are often asymptomatic and usually present with unilateral exophthalmos 4,10 or symptoms related to the central nervous system. The disease usually starts in one sinus and relentlessly spreads to adjacent structures.…”