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Clinical Problem Solving: Radiology
September 2004

Radiology Quiz Case 4—Diagnosis

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Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2004

Arch Otolaryngol Head Neck Surg. 2004;130(9):1126-1127. doi:10.1001/archotol.130.9.1126

Allergic fungal sinusitis is generally recognized as a disease that is distinct from other forms of fungal sinusitis. It most commonly presents in adolescents and young adults, with approximately two thirds of patients reporting a history of allergic rhinitis, and half reporting a history of asthma. Clinical presentation varies from subtle nasal obstruction and crusting to extensive polyposis, chronic sinusitis, acute visual loss, proptosis, and facial dysmorphia. The pathogenesis of AFS is unclear, but immunologic and histologic data suggest that it represents an immunologically mediated disorder rather than an infectious entity. Cultures from patients with AFS most commonly yield organisms from the dematiaceous family of fungi, including Bipolaris.1 Bent and Kuhn2 identified 5 common characteristics (ie, type I hypersensitivity, nasal polyposis, characteristic radiographic findings, eosinophilic mucin without invasion, and positive fungal stain) among 15 cases of AFS.

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