deShazo R D, O'Brien M, Chapin K, Soto-Aguilar M, Swain R, Lyons M, Bryars W C, Alsip S
Department of Medicine, College of Medicine, University of South Alabama, Mobile 36617, USA.
J Allergy Clin Immunol. 1997 Apr;99(4):475-85. doi: 10.1016/s0091-6749(97)70073-3.
Recent improvements in the treatment options for fungal disease of the sinuses make rapid distinction between the syndromes of invasive and noninvasive sinusitis necessary. On the basis of the extensive review of the literature detailed here, we developed case-finding criteria for the noninvasive syndrome of sinus mycetoma. Using these criteria, we identified 20 cases of sinus mycetoma in the medical literature and compared findings in these patients to those of five patients with mycetoma evaluated in our clinics. Like those in the literature, our patients appeared immunocompetent and were often first seen for evaluation of symptoms other than those usually associated with sinusitis. Two were first seen with a new-onset seizure disorder and one with nasal obstruction alone. Patients from both groups more commonly had mycetoma in their maxillary sinuses, and fungus failed to grow from the cheesy, grey-green, hyphae-rich material removed at the time of surgery. Clinical features in our five patients, which are not noted in published reports of sinus mycetoma, included frequent atopy, nasal polyps, calcification within the sinus on computed tomography, and an excellent response to surgical treatment. Serendipitously, one patient had both allergic fungal sinusitis and a mycetoma in the same sinus. On the basis of this experience, we have modified our case-finding criteria into proposed diagnostic criteria for sinus mycetoma. The elements of these criteria are designed to: (1) exclude patients with invasive fungal sinusitis and (2) differentiate sinus mycetoma from other forms of noninvasive fungal sinusitis on the basis of specific histopathologic findings. This study and the criteria presented reflect our view that sinus mycetoma represents a distinct but not necessarily isolated element in the spectrum of noninvasive fungal disease of the sinuses.
鼻窦真菌病治疗方案的近期进展使得快速区分侵袭性和非侵袭性鼻窦炎综合征成为必要。基于此处详细的文献综述，我们制定了鼻窦真菌球非侵袭性综合征的病例发现标准。使用这些标准，我们在医学文献中确定了20例鼻窦真菌球病例，并将这些患者的检查结果与在我们诊所评估的5例真菌球患者的结果进行了比较。与文献中的患者一样，我们的患者免疫功能正常，最初就诊时常常是因为评估一些并非通常与鼻窦炎相关的症状。其中2例最初就诊时患有新发癫痫障碍，1例仅表现为鼻塞。两组患者上颌窦更常出现真菌球，手术时从奶酪样、灰绿色、富含菌丝的物质中未能培养出真菌。我们5例患者的临床特征在已发表的鼻窦真菌球报告中未被提及，包括频繁的特应性、鼻息肉、鼻窦计算机断层扫描显示钙化以及对手术治疗的良好反应。偶然发现，1例患者在同一鼻窦同时患有变应性真菌性鼻窦炎和真菌球。基于这一经验，我们已将病例发现标准修改为鼻窦真菌球的拟诊标准。这些标准的要素旨在：（1）排除侵袭性真菌性鼻窦炎患者；（2）根据特定的组织病理学发现将鼻窦真菌球与其他形式的非侵袭性真菌性鼻窦炎区分开来。本研究及所提出的标准反映了我们的观点，即鼻窦真菌球代表鼻窦非侵袭性真菌病谱系中一个独特但不一定孤立的要素。
