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April 11, 1994

Invasive or Allergic Fungal Sinusitis?

Arch Intern Med. 1994;154(7):815. doi:10.1001/archinte.1994.00420070145017

With regard to the article by Ismail et al,1 I was the otolaryngologist who performed four of the five operative procedures. Having treated several patients with allergic fungal sinusitis secondary to dematiaceous fungi, I am quite confident that this also represented a case of allergic fungal sinusitis. IgE-modified RAST (radioallergosorbent test) for dematiaceous fungi and specifically Curvularia lunata unfortunately was not performed. However, the total serum IgE level was elevated, and allergic mucin with marked eosinophilia was also present in addition to extensive nasal polyposis.2

The initial surgical procedure was a transseptal sphenoidotomy that disclosed a thick green or brown paste material within the expanded sphenoid cavity. There was bone erosion secondary to mass effect; however, no true invasion was evidenced by either intravascular fungal spread or extensive granulation tissue formation. There was no true intracranial extension or cerebrospinal fluid leak (Figure 1, right, was a computed tomographic

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