Alotaibi Naif H, Aljasser Latifa A, Arnaout Rand K, Alsomaili Safia
Department of Otolaryngology-Head & Neck, King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh, Saudi Arabia; Department of Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2021 Nov;88:106479. doi: 10.1016/j.ijscr.2021.106479. Epub 2021 Oct 7.
Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis with nasal polyps. It is characterized by eosinophilic mucin, which results from an inflammatory reaction to non-invasive fungal hyphae in the rhino-sinuses. It is clinically recognizable due to the criteria set by Bent and Kuhn. The treatment approach is multimodal, and the main treatment approach is surgical debridement, followed by a course of oral and/or topical corticosteroids to decrease recurrence post-surgery. This case report aims to illustrate the effect of Dupilumab, on the number of relapse episodes in a patient and the associated parameters.
Herein we report a case of a 40-year-old woman referred to our institution as a case of refractory AFRS for which she underwent four functional endoscopic sinus surgeries (FESS) and was on maximum medical treatment. She presented with complaints of facial fullness and pain, headache, and purulent discharge. After another trial of surgery which did not control her symptoms, she was assessed for criteria to start biological treatment. The symptoms were successfully controlled after initiation of the agent, and she was followed up using multiple subjective and objective measures.
AFRS is a non-invasive immune-mediated sub-clinical entity of chronic rhinosinusitis. A multimodal approach to its treatment based on surgical debridement with medical therapy has shown positive outcomes. In this case we present significant improvement after administering Dupilumab; therefore, suggesting its addition to the treatment regimen of refractory AFRS.
变应性真菌性鼻-鼻窦炎（AFRS）是慢性鼻-鼻窦炎伴鼻息肉的一种亚型。其特征为嗜酸性黏液，这是鼻窦对非侵袭性真菌菌丝发生炎症反应的结果。根据本特（Bent）和库恩（Kuhn）设定的标准，该病在临床上可识别。治疗方法是多模式的，主要治疗方法是手术清创，随后进行一个疗程的口服和/或局部使用皮质类固醇，以减少术后复发。本病例报告旨在说明度普利尤单抗对一名患者复发次数及相关参数的影响。
在此，我们报告一例40岁女性患者，她因难治性AFRS转诊至我院，为此她接受了四次功能性鼻内镜鼻窦手术（FESS），并接受了最大剂量的药物治疗。她主诉面部胀满、疼痛、头痛和脓性分泌物。在又一次手术尝试未能控制其症状后，对她进行了启动生物治疗的标准评估。在开始使用该药物后，症状得到成功控制，并使用多种主观和客观指标对她进行了随访。
AFRS是慢性鼻-鼻窦炎的一种非侵袭性免疫介导的亚临床实体。基于手术清创和药物治疗的多模式治疗方法已显示出积极的效果（原文此处表述有误，已修正）。在本病例中，我们展示了使用度普利尤单抗后的显著改善；因此，建议将其添加到难治性AFRS的治疗方案中。
