Abstract
We report two cases of allergic fungal rhinosinusitis (AFS) caused by Aspergillus.
Case 1, 51-year-old man reporting left nasal discharge and blockage was found in macroscopic examination to have a polyp in the left nasal cavity. CT showed shadows high-density internal and low-density peripheral in the left anterior ethmoid sinus, frontal sinus, and maxillary sinus. Endoscopic endonassal sinus surgery showed marked eosinophilic infiltration and accumulation of allergic mucin accompanied by eosinophil-derived granular proteins such as MBP and concomitant fungi (Aspergillus) in the affected paranasal sinus, yielding a diagnosis of AFS caused by Aspergillus. Due to untreated diabetes disease, steroid therapy could not be used, the paranasal sinus was washed with antifungal agents and heparin in addition to surgical opening and drainage. Ten months after surgery, the man is healing satisfactorily.
Case 2, 54-year-old man reporting nasal discharge and blockage was found in macroscopic examination to have a polyp in the left nasal cavity. CT showed shadows high-density internal and low-density peripheral in the maxillary sinus and sphenoidal sinus, suggesting left pansinusitis. Endoscopic endonassal sinus surgery showed the presence of fungi (Aspergillus) in allergic mucin accumulated in the paranasal cavity, yielding a diagnosis of AFS. In addition to this surgery, the man was treated with systemic steroids and nasal washing with saline. Nine months after surgery, the man is healing satisfactorily.
AFS is reported to have high recurrence as refractory chronic sinusitis. Our two patients show satisfactory postoperative in a short period of 9 to 10 months, but will require regular long-term follow-up.
