Allergic fungal sinusitis involving the lacrimal sac: a case report and review.
BACKGROUNd: We report a case of allergic fungal sinusitis (AFS) involving the lacrimal sac and review the current English literature. A literature search for AFS involving the lacrimal sac revealed two reports with only one of the two cases demonstrating histological evidence of fungal elements. This is just the third such case and only the second reported case with histopathologic confirmation of fungal elements by Gomori methenamine silver (GMS) stain.


METHODS
A PubMed database search was performed using combinations of the following key words: allergic fungal sinusitis, lacrimal sac, nasolacrimal duct, ophthalmology, epiphora, orbit. A 70-year-old white man with a history of chronic conjunctivitis and nasal polyps presenting with chronic epiphora was found to have dacryostenosis on the left side. A CT scan of the orbits revealed mucoperiosteal thickening completely obliterating the frontal, ethmoid and sphenoid sinuses.


RESULTS
A left external dacryocystorhinostomy (DCR) was performed and the lacrimal sac contents were studied histopathologically. Microscopic examination of the lacrimal sac contents disclosed allergic mucin with laminated aggregates of eosinophils in various stages of degeneration, Charcot-Leyden crystals and rare noninvasive fungal hyphae confirming the diagnosis of AFS. Fungal elements stained positively with Gomori methenamine silver stain.


CONCLUSIONS
Although rarely reported, AFS can affect the lacrimal sac. AFS should be suspected in patients with a history of recurrent refractory sinusitis, recurrent dacryocystitis and nasal polyposis. Early diagnosis is important for adequate treatment and prevention of recurrence.
Wills Eye Institute at Thomas Jefferson University , Philadelphia, PA , USA .
Kristina Y
KY
Pao
Vladimir
V
Yakopson
Joseph C
JC
Flanagan
Ralph C
RC
Eagle
D000368:Aged; D003608:Dacryocystorhinostomy; D004804:Eosinophils / Q000276:immunology / Q000473:pathology; D015821:Eye Infections, Fungal / Q000000981:diagnostic imaging / Q000382:microbiology*; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging / Q000382:microbiology*; D008297:Male; D009077:Mucins / Q000276:immunology; D009181:Mycoses / Q000000981:diagnostic imaging / Q000382:microbiology*; D009301:Nasolacrimal Duct / Q000000981:diagnostic imaging / Q000382:microbiology*; D065631:Rhinitis, Allergic / Q000000981:diagnostic imaging / Q000382:microbiology*; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity / Q000502:physiology
D009077:Mucins
Allergic fungal sinusitis; lacrimal sac; nasolacrimal duct