Berrettini S, Carabelli A, Papini M, Ciancia E, Sellari Franceschini S
Istituto di Clinica Otorinolaringoiatrica, Università di Pisa.
Acta Otorhinolaryngol Ital. 1996 Oct;16(5):447-54.
Allergic Fungal Sinusitis (AFS) is a newly recognized form of benign, non invasive sinusitis the histopathologic features of which are similar to those of allergic bronchopulmonary aspergillosis. AFS is a rare condition. However, because treatment and prognosis vary widely, it is important that this disorder be recognized and differentiated from chronic bacterial sinusitis and other forms of fungal sinusitis. AFS does not discriminate by age although it is primarily found in young adults. AFS patients are usually atopic, often having a history of asthma and nasal polyposis. Many have suffered from the symptoms of chronic sinusitis for years while others have had multiple sinus surgery. Radiographs reveal the involvement of multiple sinuses, often with bone destruction. Laboratory findings support an allergic state with a marked increase in eosinophilia and total IgE. At times RAST testing proves positive for fungi and immediate cutaneous reactivity to fungi is also present. Histologic review of the sinus contents reveals characteristic "allergic mucin", with numerous eosinophiles, Charcot-Leyden crystals and fungal hyphae, without any fungi tissue invasion. A wide variety of fungal agents has been implicated, although the majority belong the Dematiacee family. Those patients with allergic mucin but no documented fungi are indicated as having AFS-like syndrome. The pathogenesis of AFS is uncertain. There is controversy in the literature as to what role hypersensitivity (Gell and Coombs type I and type III responses) in infection play. To date current therapeutic recommendations include complete exenteration of all allergic mucin. Adjunctive, short-term systemic steroids often prove useful and nasal steroid spray should be continued for long term. Systemic antifungal agents are not recommended in AFS. Recurrence is common and thus close clinical, endoscopic and radiographic follow-up is important. The clinicopathologic features of one patient with AFS are reported and etiopathogenetic problems are discussed. The presented case showed a positive culture with negative immunological testing (RAST-positive and immediate cutaneous reactivity to fungal antigen), thus confirming the pathogenetic hypothesis of the saprophytic fungal growth in an atopic patient.
变应性真菌性鼻窦炎（AFS）是一种新认识的良性、非侵袭性鼻窦炎，其组织病理学特征与变应性支气管肺曲霉菌病相似。AFS是一种罕见疾病。然而，由于治疗方法和预后差异很大，识别这种疾病并将其与慢性细菌性鼻窦炎及其他类型的真菌性鼻窦炎区分开来很重要。AFS并不受年龄限制，尽管主要见于年轻人。AFS患者通常为特应性体质，常伴有哮喘和鼻息肉病史。许多患者多年来一直有慢性鼻窦炎症状，还有一些患者接受过多次鼻窦手术。X线片显示多个鼻窦受累，常伴有骨质破坏。实验室检查结果支持变应性状态，嗜酸性粒细胞和总IgE显著升高。有时变应原特异性IgE检测对真菌呈阳性，且对真菌的即刻皮肤反应性也存在。鼻窦内容物的组织学检查显示特征性的“变应性黏液”，有大量嗜酸性粒细胞、夏科-莱登结晶和真菌菌丝，无任何真菌组织侵袭。尽管大多数真菌属于暗色孢科，但多种真菌病原体都与之相关。那些有变应性黏液但无真菌记录的患者被诊断为AFS样综合征。AFS的发病机制尚不确定。关于超敏反应（Gell和Coombs I型和III型反应）在感染中起何种作用，文献中存在争议。迄今为止，目前的治疗建议包括彻底清除所有变应性黏液。辅助性短期全身用类固醇通常很有用，鼻用类固醇喷雾剂应长期持续使用。AFS不推荐使用全身抗真菌药。复发很常见，因此密切的临床、内镜和影像学随访很重要。本文报告了1例AFS患者的临床病理特征，并讨论了病因发病问题。该病例培养结果阳性而免疫检测阴性（变应原特异性IgE检测阳性且对真菌抗原的即刻皮肤反应性阳性），从而证实了特应性患者腐生性真菌生长的发病机制假说。
