Allergic fungal sinusitis presenting with proptosis and diplopia: a review of ophthalmologic complications and treatment.
Allergic fungal sinusitis is a noninvasive, but vigorous, inflammatory response to mold that occurs in immunocompetent patients with chronic sinusitis and nasal polyposis. It typically occurs in patients who have a history of atopic disease. Occasionally, the patients with allergic fungal sinusitis present with ophthalmic signs and symptoms--most commonly proptosis and diplopia. We report the case of a 23-year-old man with right-sided proptosis, diplopia, and nasal obstruction. He had a history of sinusitis in the past. On presentation, sinus computed tomography scan showed pansinusitis. Subsequent workup revealed elevated immunoglobulin E and positive skin testing to several molds including Bipolaris spicifera and Aspergillus fumigatus. Functional endoscopic sinus surgery was performed, and the surgical specimen revealed allergic mucin with eosinophils, Charcot-Leyden crystals, and a silver stain showing fungal elements. His symptoms, including proptosis and diplopia, improved after surgical debulking and use of systemic corticosteroids.
Coop
Christopher A
CA
Department of Internal Medicine, 5 MDG/MDOS/SGOKI, 5th Medical Group, Minot Air Force Base, North Dakota 58705, USA. christopher.coop@juno.com
England
Ronald W
RW
D000328:Adult; D004172:Diplopia / Q000209:etiology*; D005094:Exophthalmos / Q000209:etiology*; D005658:Fungi / Q000276:immunology*; D006801:Humans; D006967:Hypersensitivity / Q000150:complications*; D008297:Male; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000601:surgery