Allergical Fungal Sinusitis with Intracranial Abscess - A Case Report and Literature Review

黴菌性鼻竇炎併大腦膿腫－病歷及文獻回顧

張志任(Chih-Zen Chang) ； 黃旭霖(Shiuh-Lin Hwang) ； 洪純隆(Shen-Long Howng)

《The Kaohsiung Journal of Medical Sciences》 13卷11期 (1997/11) Pp. 685-689

https://doi.org/10.6452/KJMS.199711.0685

摘要

過敏性黴菌性竇炎是一種近年來才被詳細描述的病名；一般發生於先天性過敏體質或後天性免疫機能降低的患者身上，儘管侵犯顱骨基部的速度非常緩慢，但也有可能造成顱骨基部損壞，腦神經的壓迫，並形成硬腦膜外或硬腦膜內腦內膿腫。
我們回顧此一病例，其初期症狀為經常性鼻塞、流鼻涕、甚至於流鼻血而至耳鼻喉科門診及隨後的鼻竇手術，手術中發現鼻中膈肥厚並充血，黏稠性黃綠色及棕色塊狀物，患者於住院前已有氣喘及異位性皮膚炎，住院期間併發腦部膿腫。經手術引流後加上藥物治療後，情況良好而出院，目前尚門診追蹤中。過敏性黴菌性鼻竇炎必須和慢性細菌性鼻竇炎及慢性黴菌性鼻竇炎作區分，前者有一定的過敏體質，通常是過敏反應第一型，黴菌感染以麴菌屬為主。高復發率是其特色，需要醫護人員高度的警覺性。

並列摘要

Fungus infection of the sinunasal tract usually follows a slow, nonaggressive course. With massive bone destruction or along the foramen of skullbase, the disease may extend outside the confines of the sinunasal tract even into intracranum, causing cerebral epidural, subdural and intracerebral abscess.
Recently, allergic fungal sinusitis (AFS) has been a described disease entity, usually occurring in immunocomponent individuals. Early reports cited Aspergillus as the causative organism. It Is now recognized that the dematiaceous fungi, including Bipolaris, Culvularla, Exserohilum, and Alternaria are associated with AFS.
The disease typically follows a slow, mild course and dose not invade tissue, although pressure in the sinus can eventually cause expansion and erosion of the sinus walls.
We report a case who was presented with right facial swelling and numbness, right vision loss, right hearing loss as well as deficit in cranial nerve III, IV, V, VI. A gangrene was found in right upper concha. A biopsy was done and fungal hyphae was noted. The brain MRI revealed right temperal tip abscess; he was then transfered to our ward for further surgeical treatment. The pathological findings revealed Aspergillus.
A new diagnostic entity, “skull base allergical fungal sinusitis” (SBAFS) as issued, could corporate the histological diagnostic criteria and the computed tomography of bone erosion in this case. Biopsy in the sinus and the brain is necessary to rule out fungus or tumor invasion. The awareness and corporation between otolaryngologists, ophthalmologists, and neurosurgeone with the disease can avoid delayed diagnosis and promote early treatment.

並列關鍵字

allergic fungal sinusitis ； skull base ； brain abscess