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European Archives of Oto-Rhino-Laryngology

, Volume 260, Issue 6, pp 331–335 | Cite as

Allergic Aspergillus flavus rhinosinusitis: a case report from Qatar

  • Saad J. Taj-AldeenEmail author
  • Ali A. Hilal
  • Agustin Chong-Lopez
Rhinology

Abstract

Fungal involvement in rhinosinusitis is classified into four major forms: allergic, mycetoma, chronic invasive (indolent) and acute invasive (fulminant). It can become life threatening if not diagnosed and treated properly. The preliminary diagnosis is usually made by nasal endoscopy and computed tomography (CT) imaging, but tissue biopsy and culture are of vital importance in confirming the disease and in planning treatment. We present a case of allergic fungal rhinosinusitis (AFS) caused by Aspergillus flavus. The clinical manifestation of the disease was the presence of an extensive left nasal polyp. An allergic workup revealed systemic eosinophilia (11.7%), high serum IgE levels (1,201 IU/ml) and a positive skin test for Aspergillus. CT scan showed a total opacification and expansion of the left nasal cavity and sinuses, with a secondary inflammatory reaction on the right side. There was no bony erosion beyond the sinus walls. The patient was operated on using an endoscopic approach (polypectomy and ethmoidectomy), where an abundant amount of allergic fungal mucin and dark crusts were found filling the sinuses. Fungal hyphae were evident in histopathological sections of the removed mucin. Culture of the debris resulted in the growth of Aspergillus flavus. The patient received a full course of systemic and topical steroids. The serum IgE level had dropped to 353 IU/ml and the peripheral eosinophil count to normal (1.38%) by the 10th postoperative month. Surgical debridement and corticosteroids may keep the disease quiescent for a long time.

Keywords

Aspergillus flavus Allergic rhinosinusitis Polyp Histopathology 

Notes

Acknowledgements

We thank Professor Dr. Henrik Hellquist (Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Qatar) for his interest throughout this work and for comments on an early version of the manuscript.

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Saad J. Taj-Aldeen
    • 1
    Email author
  • Ali A. Hilal
    • 2
  • Agustin Chong-Lopez
    • 1
  1. 1.Department of Laboratory Medicine and PathologyHamad Medical CorporationDohaQatar
  2. 2.Department of Surgery, ENT SectionHamad Medical CorporationDohaQatar

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