印度尼西亚老年患者的罕见变应性真菌性鼻鼻窦炎病例报告及诊断流程
A rare case of allergic fungal rhinosinusitis in Indonesian elderly: A case report and diagnostic procedure.
作者信息
Widhiono Drean Ferrys, Sutikno Budi
机构信息
Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
出版信息
Ann Med Surg (Lond). 2021 May 21;66:102400. doi: 10.1016/j.amsu.2021.102400. eCollection 2021 Jun.
BACKGROUND
Allergic fungal rhinosinusitis (AFRS) is a rare case.
CASE PRESENTATION
A 63-year-old-man presented right nasal congestion one year ago. There was a polyp in the right nasal cavity supported CTScan showed a solid mass with central hyperattenuating of ±8.4 × 2.4 × 4.4 cm. Total IgE value was 1,227 IU/ml, while Aspergillus specific IgE and Mucorous specific IgE using the micro-Elisa technique were negative or less than 0.35 IU/ml. The skin prick test was positive on exposure to house dust, cotton, chicken meat, and cow's milk. Mucosal polypoid and allergic mucin were found during functional endoscopic sinus surgery (FESS). Histopathology showed inflammatory cells of eosinophils.
DISCUSSION
These results lead to a diagnosis of AFRS according to the Bent and Kuhn criteria. The highest incidence rate is in adolescents and young adults but it occurs in the elderly. So, some of the signs and symptoms of AFRS in adolescents and young adults do not appear.
CONCLUSION
AFRS can only be diagnosed during FESS when mucins are found, this case appear in the elderly to be very interesting.
背景
变应性真菌性鼻-鼻窦炎（AFRS）是一种罕见病例。
病例报告
一名63岁男性于一年前出现右侧鼻塞。右侧鼻腔有一个息肉，CT扫描显示为一个实性肿块，中心密度增高，大小约为8.4×2.4×4.4厘米。总IgE值为1227 IU/ml，而采用微量酶联免疫吸附测定技术检测的曲霉特异性IgE和黏液特异性IgE为阴性或低于0.35 IU/ml。皮肤点刺试验在接触屋尘、棉花、鸡肉和牛奶时呈阳性。在功能性鼻内镜鼻窦手术（FESS）中发现了黏膜息肉样变和变应性黏液。组织病理学显示有嗜酸性粒细胞炎症细胞。
讨论
根据本特和库恩标准，这些结果导致AFRS的诊断。发病率最高的是青少年和年轻人，但也发生在老年人中。因此，青少年和年轻人中AFRS的一些体征和症状并未出现。
结论
只有在FESS中发现黏液时才能诊断AFRS，该病例出现在老年人中非常有趣。
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