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Presented by Pedram Argani, M.D. and prepared by Jeffrey T. Schowinsky, M.D.
Case 2: 21 year old female with a sinus headache.
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1. Question
Week 282: Case 2
21 year old female with a sinus headache./images/091106PA2a.jpg
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Answer: Allergic fungal sinusitis
Histology: The biopsy consists of thickened mucus which contains layered clusters of degenerating inflammatory cells. Closer inspection reveals eosinophilic granules within leukocytes with bilobed nuclei, diagnostic of eosinophils. Charcot-Leyden crystals are identified. These are the typical features of allergic fungal sinusitis. Silver stain (GMS) revealed scattered fungal hyphae within this material.
Discussion: Chronic sinusitis is a non-specific description, typically reserved for cases with a mild to moderate lymphoplasmacytic infiltrate without prominent eosinophils. Invasive fungal sinusitis typically occurs in severely immunocompromised, neutropenic persons, and features tissue necrosis and vascular invasion by fungi without a prominent inflammatory reaction. The treatment for invasive fungal sinusitis is emergent, radical debridement and systemic antifungals. Fungus balls occur in immunocompetent patients as colonizers. Treatment of a fungus ball is debridement and aeration. Allergic fungal sinusitis is also best treated by debridement and aeration, but with the addition of steroids.
Reference(s):
– New England Journal of Medicine 1997; 337: 254-258.Incorrect
Answer: Allergic fungal sinusitis
Histology: The biopsy consists of thickened mucus which contains layered clusters of degenerating inflammatory cells. Closer inspection reveals eosinophilic granules within leukocytes with bilobed nuclei, diagnostic of eosinophils. Charcot-Leyden crystals are identified. These are the typical features of allergic fungal sinusitis. Silver stain (GMS) revealed scattered fungal hyphae within this material.
Discussion: Chronic sinusitis is a non-specific description, typically reserved for cases with a mild to moderate lymphoplasmacytic infiltrate without prominent eosinophils. Invasive fungal sinusitis typically occurs in severely immunocompromised, neutropenic persons, and features tissue necrosis and vascular invasion by fungi without a prominent inflammatory reaction. The treatment for invasive fungal sinusitis is emergent, radical debridement and systemic antifungals. Fungus balls occur in immunocompetent patients as colonizers. Treatment of a fungus ball is debridement and aeration. Allergic fungal sinusitis is also best treated by debridement and aeration, but with the addition of steroids.
Reference(s):
– New England Journal of Medicine 1997; 337: 254-258.
