Complicated allergic fungal rhinosinusitis: diagnostic complexities and management strategies.
Oliver Skan, Laurie Springford, Samit Unadkat
✦ AI-curated · Sources linked
Case in brief
A man in his 60s presented with diplopia, headache, and facial numbness, leading to a diagnosis of bilateral abducens nerve palsy and partial right third nerve palsy. Imaging revealed an erosive fungal lesion in the sphenoid sinus. Following functional endoscopic sinus surgery, he was treated with corticosteroids and systemic antifungals. His diplopia persisted for 8 weeks but resolved completely by twelve weeks.
What made this case unusual
The case illustrates the diagnostic complexities of allergic fungal rhinosinusitis, particularly with ocular complications and the absence of identifiable fungal organisms despite significant histopathological findings.
Diagnostic / clinical pearl
Clinicians should consider chronic allergic fungal sinusitis in patients presenting with ocular symptoms and be aware of the potential for significant neurological involvement.
Why it matters
This case underscores the importance of a multidisciplinary approach in diagnosing and managing complicated allergic fungal rhinosinusitis, particularly when neurological symptoms are present.