Pediatric Allergic Fungal Rhinosinusitis with Extensive Intr
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• Allergic fungal sinusitis (AFRS) has become increasingly common. It’s defined as a noninvasive, benign inflammatory fungal disease of the sinuses which develops in young adults and adolescents.

• AFRS can present clinically in different ways. Its presentation can range from simple nasal obstruction to signs and symptoms of intra-orbital and/or intracranial complications.

• In pediatric cases being very aggressive, Careful clinical evaluation, detailed histopathological examination to rule out mixed types and malignancies.

• Lifelong follow up should be done to manage the recurrence.

AFRS with intracranial extradural extension: 15 years old male presented with nasal discharge and obstruction, occasional headache with a positive history of allergic symptoms. Examination of the nose showed bilateral grade 4 nasal polyps and thick fungal mucin filling both nasal cavities. CT sinuses showed extensive disease with a marked expansion of the sinuses with dehiscence of the posterior wall and intracranial extension. MRI showed right frontal sinus expansion and intracranial extension limited by an intact dura. MR imaging is indicated in all extensive cases of fungal sinusitis with suspected intracranial and or intraorbital involvement, with the differential diagnosis of allergic fungal sinusitis, invasive fungal sinusitis, and extensive mucopyoceles.

The polyps and fungal mucin were entirely removed from the nasal cavities, bilateral wide maxillary sinus antostomies, and thick mucin was aspirated. The anterior and posterior ethmoid sinuses were full of polyps, mucin, and fungal mud which was aspirated. The frontal recesses and sinuses were full of polyps, mucin, and fungal mud causing erosion of frontal floors and displacing the orbits, all were cleaned, drained with the help of navigation. The pulsating intact dura was observed and cleaned from the thick mucin, and fungal mud with no CSF leak observed.

The patient was managed by a short course of systemic oral steroid, topical steroid sprays, and continuous nasal saline irrigations. The patient continued to have regular endoscopic follow up with no signs of recurrence after four years, as demonstrated by the clear postoperative CT scan sinuses