Rhinitis caseosa, nasal cholesteatoma and allergic fungal sinusitis.
ABSTRACT The recently described Syndrome of Allergic Fungal Sinusitis (AFS) has many similarities with the previously described entity of rhinitis Caseosa (synonym-Nasal Cholesteatoma). 28 patients treated over a 6 year period with a diagnosis of rhinitis caseosa/nasal cholesieatoma have been retrospectively reviewed with regard to their clinical and radiological features, operative findings and microbiologic and histopathologual features.All cases presented with nasal obstruction and nasal polyposis. CT scanning indicated intracranil extension and intra-orbital extension m 9 cases each. Surgical debridetnent with establishment of sinus drainage led to the universal initial relief of symptoms in all cases. 26 of 28 cases have remained free of recurrence on prolonged follow-up (minimum follow-up one year).Despite these cases demonstrating clinical, radiologital, morphological and histological similarities with the Syndrome of Allergic Fungal Sinustitis, in only 2 cases was a fungal aetiology confirmed by history. The clinical syndrome of "Rhinitis Caseosa" is described and its relationship with the Allergic Fungal Sinusitis (AFS) syndrome and the "AFS-hke" Syndrome explored.
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ABSTRACT: Although first described in 1983, allergic Aspergillus sinusitis (AAS) has yet to gain wide recognition among otolaryngologists and pathologists. We have treated three patients with a history of asthma, nasal polyposis, and recurrent pansinusitis who fit the description of allergic Aspergillus sinusitis. Histopathologically, mucinous material with abundant eosinophils and Charcot-Leyden crystals ("allergic mucin") is interspersed with fungal hyphae. Immunologic characteristics include serum total immunoglobulin E (IgE) elevation, increased RAST classes, and cutaneous reactivity to molds. A retrospective analysis of the histopathology of 82 patients with chronic sinusitis was also undertaken. Eleven additional patients with classic allergic mucin were identified, but were found to be without evidence of fungal elements. The clinical features of all 14 patients are reviewed revealing the spectrum of disease. The difficulties of diagnosis and a therapeutic protocol which includes wide local debridement and postoperative use of systemic steroids are discussed.The Laryngoscope 09/1991; 101(8):815-20. · 1.98 Impact Factor
Article: Allergic fungal sinusitis.[Show abstract] [Hide abstract]
ABSTRACT: Allergic fungal sinusitis (AFS) is a noninvasive disease first described as a distinctive clinical and histopathologic entity more than 10 years ago. The typical patient is immunocompetent, atopic, has chronic sinusitis refractory to medical therapy, and 100% of those we have diagnosed have nasal polyps. Because of the histopathologic similarity to mucoid impaction of the bronchi seen in allergic bronchopulmonary aspergillosis, Aspergillus species were initially suspected as the causative agent. Subsequent reports include a number of non-Aspergillus-related cases. Both we and others have found a 7% incidence of AFS among chronic sinusitis patients requiring surgery. Relapse after surgical debridement and aeration is common and often responds to systemic corticosteroids. The diagnosis of AFS should be considered in all atopic patients with nasal polyps and chronic sinusitis. The clinical and histopathologic features of this disorder are reviewed.Allergy proceedings: the official journal of regional and state allergy societies 01/1990; 13(1):3-6.
Article: Rhinitis caseosa.South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 10/1973; 47(37):1693-4. · 1.70 Impact Factor