Allergic Fungal Rhinosinusitis Presenting with Rapidly Progressive Visual Loss-Case Report

過敏性黴菌性鼻竇炎合併突發性視力喪失－病例報告

張芳瑜(Fang-Yu Chang) ； 吳佳臻(Chia-Chen Wu) ； 李達人(Ta-Jen Lee) ； 黃啟哲(Chi-Che Huang) ； 張伯宏(Po-Hung Chang) ； 傅嘉祥(Chia-Hsiang Fu)

《台灣耳鼻喉頭頸外科雜誌》 54卷2期 (2019/06) Pp. 111-116

https://doi.org/10.6286/jtohns.201906_54(2).111

摘要

Allergic fungal rhinosinusitis (AFRS) is a noninvasive fungal sinusitis involving an immune response. Although rare, early detection of AFRS is important to prevent subsequent intracranial and intraorbital extension and the high recurrence rate. We report a case of a 30-year-old male who was suffering from bilateral nasal obstruction and purulent rhinorrhea for 6 months. Although his symptoms improved after medical treatment, he subsequently experienced rapid visual loss in his left eye. Visual acuity test revealed 20/400 (decimal visual acuity 0.05). Sinonasal computed tomography scan revealed an expansile lesion centered in the bilateral posterior ethmoid and sphenoid sinuses, which impinged on the left superior orbital fissure, optic canals, and cavernous sinuses. Transnasal endoscopic exploration was performed, which demonstrated severe edematous sinus mucosa and peanut butter-like material filling the bilateral sphenoid sinuses that was removed meticulously. After the operation, the visual acuity test of his left eye recovered to 20/32 (decimal visual acuity 0.63). Meanwhile, he was prescribed systemic oral corticosteroids. The final pathologic report revealed AFRS, whereas the allergy test showed a positive result for Aspergillus fumigatus. In AFRS, early surgical intervention would be important to prevent permanent orbital complications, and a period of postoperative corticosteroid use is crucial to prevent recurrence.

關鍵字

Allergic fungal rhinosinusitis ； Non-invasive ； Visual loss ； Surgery ； Corticosteroid

並列摘要

過敏性黴菌性鼻竇炎屬於非侵犯性黴菌性鼻竇炎，乃是免疫系統對環境中黴菌的過敏性反應；此疾病雖然在臺灣相當罕見，但是卻具有局部骨質侵犯以及高度的復發機會，臨床上隨時注意該疾病的可能性，及時給予有效的治療以降低併發症的產生。本文報告1名30歲男性因雙側鼻塞以及黏稠的鼻內分泌物，於積極的内科治療後雖鼻部症狀改善，但病人卻發現突發性左側視力喪失，程度為20/400（同視力0.05），電腦斷層顯示雙側篩竇及蝶竇病灶，並且壓迫到左側視神經及海綿竇。經鼻内視鏡探查手術，發現雙側蝶竇佈滿腐乳狀物質並將其移除。手術後，病患左側視力恢復至20/32（同視力0.63），術後給予口服類固醇降低復發率。病理组織顯示為過敏性黴菌性鼻竇炎，另外病患的特異過敏原免疫檢驗對於煙麴黴菌呈現陽性反應。針對過敏性黴菌性鼻竇炎，即時手術介入仍是避免永久眼部併發症的關鍵，而術後的口服類固醇的使用可以降低復發機會。

並列關鍵字

Allergic fungal rhinosinusitis ； Non-invasive ； Visual loss ； Surgery ； Corticosteroid（過敏性黴菌性鼻竇炎 ； 非侵犯性 ； 視力喪失 ； 手術 ； 類固醇）