Diagnostic criteria for allergic fungal sinusitis

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Presentation transcript:

Diagnostic criteria for allergic fungal sinusitis Richard D. deShazo, MD, Ronnie E. Swain, MD  Journal of Allergy and Clinical Immunology  Volume 96, Issue 1, Pages 24-35 (July 1995) DOI: 10.1016/S0091-6749(95)70029-3 Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 1 Axial view on sinus CT scan from our 7-year-old patient showing opacification of the right ethmoid sinus and rupture of the lamina papyracea, which has produced orbital impingement and proptosis of the right eye. There is also marked mucoperiosteal thickening and a nonhomogeneous opacification of the ethmoid air cells. The foci of increased radiodensity within these cells suggests fungal infection. Journal of Allergy and Clinical Immunology 1995 96, 24-35DOI: (10.1016/S0091-6749(95)70029-3) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 2 Axial view on sinus CT scan from our 7-year-old patient showing opacification of the right maxillary sinus. There is destruction of the medial wall of the maxillary sinus from polypoid material extending into the sinus cavity. There is a nonhomogeneous concentration of dense polypoid material in the right nasal vault and in the right maxillary antrum, demonstrating fungal material of higher radiodensity. The nasal septum is displaced to the left of midline. Journal of Allergy and Clinical Immunology 1995 96, 24-35DOI: (10.1016/S0091-6749(95)70029-3) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 3 A, Low magnification photomicrograph showing laminated mucin encompassing aggregates of necrotic eosinophils from the 14-year-old patient in our series (hematoxylin-eosin stain). B, High magnification view of eosinophil Charcot-Leyden crystals within allergic mucin from the 13-year-old patient in our series. Crystals that are cut in cross-section have a hexagonal appearance (hematoxylin-eosin stain). Journal of Allergy and Clinical Immunology 1995 96, 24-35DOI: (10.1016/S0091-6749(95)70029-3) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 3 A, Low magnification photomicrograph showing laminated mucin encompassing aggregates of necrotic eosinophils from the 14-year-old patient in our series (hematoxylin-eosin stain). B, High magnification view of eosinophil Charcot-Leyden crystals within allergic mucin from the 13-year-old patient in our series. Crystals that are cut in cross-section have a hexagonal appearance (hematoxylin-eosin stain). Journal of Allergy and Clinical Immunology 1995 96, 24-35DOI: (10.1016/S0091-6749(95)70029-3) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 4 A, Low magnification view of scattered fungal hyphae within allergic mucin from the 13-year-old patient in our series (Gomori's methenamine silver stain). B, High magnification view of a branching fungal hyphus within allergic mucin for the 13-year-old patient in our series. (Gomori's methenamine silver stain). Journal of Allergy and Clinical Immunology 1995 96, 24-35DOI: (10.1016/S0091-6749(95)70029-3) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 4 A, Low magnification view of scattered fungal hyphae within allergic mucin from the 13-year-old patient in our series (Gomori's methenamine silver stain). B, High magnification view of a branching fungal hyphus within allergic mucin for the 13-year-old patient in our series. (Gomori's methenamine silver stain). Journal of Allergy and Clinical Immunology 1995 96, 24-35DOI: (10.1016/S0091-6749(95)70029-3) Copyright © 1995 Mosby, Inc. Terms and Conditions

FIG. 5 Age distribution of 99 patients diagnosed with AFS. Journal of Allergy and Clinical Immunology 1995 96, 24-35DOI: (10.1016/S0091-6749(95)70029-3) Copyright © 1995 Mosby, Inc. Terms and Conditions