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Clinical Problem Solving: Radiology
March 2003

Radiology Quiz Case 1—Diagnosis

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Copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2003

Arch Otolaryngol Head Neck Surg. 2003;129(3):375-376. doi:10.1001/archotol.129.3.373

Allergic fungal sinusitis was first described in the early 1980s by Millar et al1 in Great Britain, and by Katzenstein et al2 in the United States. Members of the family of dematiaceous fungi and Aspergillus are responsible for most cases of this disease process.37 Typically, patients are young and immunocompetent and have a history of atopic disease. The pathophysiological basis for AFS is inhalation of a fungal spore to which the patient is allergic. The patient produces copious amounts of eosinophilic mucin in response to the allergic trigger. If the normal mucociliary clearance of the nose fails to remove the spore, then the fungal spore germinates in the mucin and continues to provide an antigenic stimulus. Polyps and hyperplastic mucosa form as a result of the inflammatory stimulus.

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