ALLERGIC FUNGAL SINUSITIS - A CLINICOPATHOLOGICAL STUDY OF 16 CASES

Allergic fungal sinusitis (AFS) has been clinicopathologically defined as a noninvasive form of fungal infection. Etiologically, most report ed cases have been attributed to pigmented dematiaceous fungi. The aut hors report 16 cases of AFS from our institution, along with a review of cases from the literature. The patients' age ranged from 8 to 71 ye ars, with a mean age of 25 years. All patients were immunocompetent, a lthough six had a strong history of atopy. Multiple sinuses were affec ted in all cases; nine patients had bilateral involvement, and seven p atients manifested unilateral involvement. Histopathologically, all ca ses were characterized by the presence of ''allergic mucin,'' with sca ttered fungal organisms without invasion of mucosa or bone. Fontana-Ma sson stain identified fungi in all but one case and assisted in distin guishing the pigmented dematiaceous organisms from other septated fung al forms. Accordingly, Fontana-Masson stain can be useful in confirmin g the diagnosis of AFS in the lack of tissue culture results. Fungal c ultures performed on six cases grew Exserohilum (three cases), Bipolar is (one case), Drechslera (Bipolaris) (one case), and Curvularia (one case). All patients were treated with surgical debridement and sinus a eration. Follow-up of at least 6 months was obtained in six cases, of which four showed recurrent disease between 8 months and 4 years after the initial surgical procedure. A literature review showed that the m ost common etiologic agents were members of the dematiaceous family (8 1%), with the most common genus being Bipolaris (42%), followed by Cur vularia (21.3%). It is believed that type I and III hypersensitivity r eactions underlie the pathogenesis of this disease. Copyright (C) 1996 by W.B. Saunders Company.