Abstract
This article describes a child with advanced allergic fungal sinusitis (AFS). A 17-year-old girl with a 10-year history of chronic nasal congestion and anosmia presented with progressive headache and exophthalmos over a 3-month period. Computed tomography of the head revealed a ring-enhancing lesion in the left frontal lobe. Further imaging revealed extensive soft tissue infiltration of her sinuses contiguous with the intracranial mass and significant distortion of the sinus and orbital architecture. Biopsy specimens obtained during surgical debridement demonstrated eosinophils, yeast forms, and Charcot-Leydon crystals without evidence of fungal invasion of tissue. Fungal culture yielded Aspergillus flavus. Total serum immunoglobulin E (IgE) was markedly elevated, and precipitating antibodies to A. flavus were positive. In addition, skin test reactivity to Aspergillus species was positive. She improved after surgical debridement of the sinuses and orbits and systemic corticosteroid therapy. Allergic fungal sinusitis should be considered in any patient with sinusitis refractory to standard therapy.
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