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Case Reports
. 2020:77:698-700.
doi: 10.1016/j.ijscr.2020.11.062. Epub 2020 Nov 16.

Unilateral Exserohilum Allergic Fungal Sinusitis in a Pediatric Host: Case Report

Arwa A Al Muslat  1 , Basmah M Alghmdi  2 , Abdullah J AlShehri  3 , Rakan A Alhaidey  2 , M Anas Dababo  4 , Naif H Alotaibi  5
Affiliations
Case Reports

Unilateral Exserohilum Allergic Fungal Sinusitis in a Pediatric Host: Case Report

Arwa A Al Muslat et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Allergic fungal sinusitis (AFS) is a result of an inflammatory reaction to fungi in the nasal and paranasal sinuses. Although the causative agents of AFS vary, Exserohilum species are among the rare ones, as only a few cases have ever been reported a few times in the literature. The objective of this report is to highlight this unusual fungal type causing unilateral AFS in Saudi Arabia.

Presentation of the case: We present a case of AFS who initially presented at the age of 15 years, and was operated on in 2015 by another health care provider. He presented again in 2019 complaining of intermittent loss of smell and greenish nasal discharge, mainly from the right side for 3 months, which was associated with right-sided nasal obstruction. Based on the history and physical examination, a diagnosis of refractory chronic rhinosinusitis was made. The patient underwent functional endoscopic sinus surgery (FESS) of the paranasal sinuses and polypectomy. Histopathology of the samples taken during the surgery showed Exserohilum specie. The diagnosis of AFS was confirmed using Bent and Kuhn's criteria.

Discussion: Allergic fungal sinusitis is believed to be an allergic reaction caused by a broad spectrum of species, the majority being Aspergillus in India and Saudi Arabia. Exserohilum species are one of the rare organisms causing AFS in our region.

Conclusion: Most cases of AFS in our region have been reported to be caused by Aspergillus. Here we report a case of unilateral Exserohilum AFS in an immunocompetent pediatric patient.

Keywords: Case report; Exserohilum species; Unilateral allergic fungal sinusitis.

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Figures

Fig. 1
Fig. 1
Preoperative imaging. In coronal view, the preoperative CT shows thick mucosal swelling outlining the antrum. Expanded ethmoid air cells are found on the right side. Radiopaque fungal elements are present within the opacified ethmoid air cells.
Fig. 2
Fig. 2
10× H&E showing polypoid mucosa with chronic inflammation mainly of eosinophilic infiltration.
Fig. 3
Fig. 3
40× H&E showing the subepithelial marked eosinophilic infiltrate, with some eosinophils infiltrate the epithelial surface as well.
Fig. 4
Fig. 4
60× GMS special stain that shows the fungal elements within the allergic mucin (not in the tissue).
See this image and copyright information in PMC

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