Allergic fungal sinusitis.

In summary, AFS is a newly recognized form of sinusitis, appearing in otherwise healthy young adults with a history of chronic bacterial or polypoid rhinosinusitis refractory to conventional therapy. Radiologic study may show patchy opacification or calcifications of the sinuses on CT. The patients have an elevated total IgE, peripheral eosinophilia, and positive skin tests for fungal antigens. They may also have elevated serum fungal allergen-specific IgE and IgG and precipitating antibodies to Aspergillus, Curvularia, or other fungi. Diagnostic and therapeutic surgical drainage of the sinuses will establish a definitive diagnosis by identifying the typical allergic mucin with eosinophils, Charcot-Leyden crystals, few fungal hyphae on silver stain, and a lack of tissue invasion. Treatment, other than surgical drainage, consists of systemic corticosteroids to prevent recurrence of disease.