title: Allergic fungal rhino sinusitis with granulomas: A new entity?
abstract: BACKGROUND
  Allergic fungal rhino sinusitis (AFS) is classically described as allergic manifestation to the fungal antigen present in sinuses with no evidence of invasion. Granulomas in histopathology, suspicious of invasion, are occasionally observed in AFS and the disease in these patients behaves like invasive fungal sinusitis even without histologic evidence of invasion. We retrospectively studied AFS patients to analyze whether AFS should be continued to be designated as an allergic entity.
  
  
  METHODS
  AFS patients operated from January 2009 to July 2013 were retrospectively reviewed. Of the total 57 cases operated in last 4 years, nine showing presence of granuloma in histology were included in the AFS with granuloma Group (group 1) and the rest 48 were included in the AFS group (group 2). Both the groups were compared in terms of various parameters at presentation, treatment course and rate of recurrence.
  
  
  RESULTS
  Group 1 had significantly high rates of orbital erosion (P = .000), with positive association of skull base erosion (P = .092) and high rates of telecanthus (P = .000), diplopia (P = .000), proptosis (P = .161) and facial pain. Recurrent surgery was needed in 8 of 9 patients in the group 1 as compared to 1 of 48 patients group 2.
  
  
  CONCLUSIONS
  Granulomas suggests a more severe disease with a trend toward the invasive fungal sinusitis and alerts the clinician regarding the nature of progression. AFS seems to be a part of a continuous spectrum of fungal sinusitis rather than an allergic form as a distinct entity.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India rijuneeta@yahoo.com.
authors.forename: Rijuneeta
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sourabha Kumar
authors.initials: SK
authors.lastname: Patro
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Jagveer
authors.initials: J
authors.lastname: Yadav
authors.affiliation: Department of Medical Microbiology and Mycology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ashim
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Chatterjee
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006099:Granuloma / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012130:Respiratory Hypersensitivity / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000473:pathology; D055815:Young Adult
keywords: AFS with granulomas; allergic and invasive fungal sinusitis; allergic fungal rhino sinusitis; granulomas