Pediatric Allergic Fungal Sinusitis: Another "Great Masquerader"

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Abstract
Allergic fungal sinusitis (AFS) was first recognized as a distinct clinical entity in 1981. Since that time more than 70 case reports have been published. Nearly half of these cases are children under the age of 20 years. These children are immunocompetent with recalcitrant sinusitis, nasal polyposis, allergic rhinitis, and asthma. They may have epiphora, telecanthus, diplopia, and orbital proptosis. Computerized tomography (CT) scans demonstrate multisinus involvement with tumor-like expansion changes occurring frequently. They often have very elevated total serum immunoglobulin E (IgE) levels with increased specific fungal IgE and IgG levels and cutaneous hypersensitivity to the implicated fungus. The peanut butterlike mucin in their sinuses has characteristic findings both grossly and microscopically. Fungal elements are detectable within the mucin both microscopically and with culture. No evidence of fungal mucosal invasion should exist. Optimal treatment is uncertain although surgical debridement and postoperative systemic steroids are most commonly employed. Recurrence of disease is common with much still to be learned about this interesting disorder.

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