Objective: To discuss and analyze the diagnosis and management of allergic fungal sinusitis.
Method: Three middle-aged patients with allergic fungal sinusitis (AFS) were observed. The histological diagnosis was made on the mucous material and allergy evaluation based on the strong history of inhalant mold allergies, a positive result of skin test, total immunoglobulin E level and radioallergosorbent test to fungal antigens. The management included wide local endoscopic sinus debridement, adequate sinus aeration, postoperative use of systemic and intranasal corticosteroid. Systemic antifungal therapy was not used.
Results: All 3 patients were immunocompetent and none demonstrated histologic evidence of tissue invasion. Two patients remained disease-free during follow-up ranging for a mean of 16 months, 1 patient recurred 17 months after operation and symptom-free for 2 months after re-cleaning of the sinus cavity.
Conclusion: Diagnosis of AFS required a high index of suspicion. A confirmatory diagnosis was made from the inspissated mucus, clinical and CT findings along with careful communication with mycologists and immunologists about the possibilities of fungal growth and allergy. Costly and lengthy courses of antibiotics, aggressive surgery should be avoided. Surgical debridement and systemic corticosteroids followed by intranasal corticosteroids might provide long-term control of AFS.