Pediatric alternating allergic fungal rhinosinusitis
The following case has been reported in the International Journal of Surgery Case Reports.

Allergic fungal rhinosinusitis (AFRS) is a truly unique pathologic entity, defined largely by the presence of allergic fungal mucin, which is a thick, tenacious, eosinophilic secretion with characteristic histologic findings.

An 8 years old girl known case of bronchial asthma, complaining of left nasal obstruction with mild eye proptosis for 9 months noticed by her parents. Her past medical and surgical histories were unremarkable. Drug history, family history and psychological history were insignificant.

Examination showed left eye proptosis, enlarged medial canthus and polyps filling the left nasal cavity. CT sinuses showed a heterogeneous opacity of the left maxillary and frontoethmoidal sinuses with bone expansion and obliteration of the left nasal cavity consistent with AFRS.

The patient underwent endoscopic sinus surgery and cleaning of the left sinuses from polyps, mud and mucin. Culture was positive for asperigillus. Initially the patient was doing well for one year follow up. However, one year later she started to complain of right nasal discharge and obstruction.

Examination revealed clear left nasal cavity with no recurrence of disease but there were right nasal polyps with mucin. CT sinuses showed recurrence of the disease in the right side with clear left nasal cavity.

The patient underwent endoscopic sinus surgery for right sinuses cleaning and polyp’s removal. Culture was positive for asperigillus. The patient had no recurrence after 3 years follow up.

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