CRITERIA FOR THE DIAGNOSIS OF SINUS MYCETOMA

Recent improvements in the treatment options for fungal disease of the sinuses make rapid distinction between the syndromes of invasive and noninvasive sinusitis necessary. On the basis of the extensive review of the literature detailed here, we developed case-finding criteria fo r the noninvasive syndrome of sinus mycetoma. Using these criteria, we identified 20 cases of sinus mycetoma in the medical literature and c ompared findings in these patients to those of five patients with myce toma evaluated in our clinics. Like those in the literature, our patie nts appeared immunocompetent and were often first seen for evaluation of symptoms other than those usually associated with sinusitis. Two we re first seen with a new-onset seizure disorder and one with nasal obs truction alone, Patients from both groups more commonly had mycetoma i n their maxillary sinuses, and fungus failed to grow from the cheesy, grey-green, hyphae-rich material removed at the time of surgery. Clini cal features in our five patients, which are not noted in published re ports of sinus mycetoma, included frequent atopy, nasal polyps, calcif ication within the sinus on computed tomography, and an excellent resp onse to surgical treatment. Serendipitously, one patient had both alle rgic fungal sinusitis and a mycetoma in the same sinus. On the basis o f this experience, we have modified our case-finding criteria into pro posed diagnostic criteria for sinus mycetoma. The elements of these cr iteria are designed to: (1) exclude patients with invasive fungal sinu sitis and (2) differentiate sinus mycetoma from other forms of noninva sive fungal sinusitis on the basis of specific histopathologic finding s. This study and the criteria presented reflect our view that sinus m ycetoma represents a distinct but not necessarily isolated element in the spectrum of noninvasive fungal disease of the sinuses.