Clinicopathological Characteristics of Eosinophilic Fungal Rhinosinusitis

Choi, Sun Myung; Chung, Yoo Sam; Jang, Yong Ju; Lee, Bong Jae

Abstract

BACKGROUND AND OBJECTIVES
Since allergic fungal sinusitis (AFS) has been described in 1983, only a few cases have been reported in the domestic scientific journals. This leads to alleviate the strict criteria because many patients with allergic mucin and fungal hyphae reveal negative results of allergic skin test or serologic tests for fungal antigens. To classify these patients, the term `eosinophilic fungal rhinosinusitis (EFS)' was first coined in 1999. The objective of this study was to evaluate the clinicopathological features of EFS. SUBJECTS AND METHOD: The authors retrospectively reviewed medical records of 21 patients who had been diagnosed as EFS between June 2002 and November 2003 at the department of otolaryngology, Asan medical center. RESULTS: Chief complaints at first visits were in the order of nasal obstruction, postnasal drip, headache, foul odor, and rhinorrhea. Nasal endoscopic findings showed nasal polyp, purulent discharge, and fungal debris. 14.2% of patients revealed no abnormal findings. All patients had increased intrasinus attenuation at non-contrast media-enhanced CT. 47.6% of patients had complete opacification of maxillary sinus predominantly. No patients had the evidence of type I hypersensitivity for fungal antigens. Twenty patients had undergone endoscopic sinus surgery and surgical specimens proved to have allergic mucin with fungal hyphae. Postoperatively, four patients (20%) had recurrent symptoms and polypoid mucosal changes, which showed responses to short term oral steroid therapy. CONCLUSION: EFS is a frequent type of fungal sinusitis if surgical specimens are carefully examined histologically. Out of patients who received endoscopic sinus surgery, bi-meatal approach for the maxillary sinus lesions, and local steroid therapy, 80% were cured with no sign of relapse. The existence of eosinophilic infiltration and allergic mucin leads us to believe that focal allergic reaction occurs inside the sinus.