Fusarium allergic fungal sinusitis

Allergic fungal sinusitis (AFS) was first reported in 1981 when Millar et al. described five patients with chronic sinusitis caused by Aspergillus fumigatus. Since that original description, multiple small series and case reports have identified Bipolaris, Curvularia, Alternaria, Rhizomucor, Exserohilum, and Chrysosporium species as culpable pathogens in AFS. Patients with AFS are immunocompetent with positive epicutaneous skin test results and serum precipitins to the relevant mold. They have high serum IgE levels, both total and mold-specific, and usually have nasal polyposis and varying degrees of asthma. In more advanced cases, they can have signs and symptoms caused by sinus cavity enlargement and erosions including orbital proptosis, diplopia, and epiphora. Surgical specimens show a characteristic thick mucin that contains large numbers of eosinophils and Charcot-Leyden crystals. Fungal hyphae are sometimes found in the mucin, and growth of a mold species to which the patient has positive immediate skin test sensitivity helps confirm the diagnosis. A new AFS pathogen is identified in the case presented below.