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Allergic Fungal Rhinosinusitis — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsAllergic Fungal RhinosinusitisSCE Infectious Diseases

A 60-year-old man presents with chronic sinusitis unresponsive to multiple antibiotic courses. CT sinuses shows dense opacification with calcification and bony remodelling. Histopathology of sinus contents shows allergic mucin with eosinophils and scattered fungal hyphae. Cultures grow Aspergillus flavus. What is the diagnosis?

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Correct answer: A — Allergic fungal rhinosinusitis (AFRS)

Allergic fungal rhinosinusitis (AFRS) is characterised by: chronic sinusitis unresponsive to antibiotics, allergic mucin containing eosinophils and Charcot-Leyden crystals, non-invasive fungal hyphae, unilateral or bilateral sinus opacification, and often elevated IgE. It is an allergic/eosinophilic response to fungal antigens (Aspergillus, Alternaria, Curvularia) — NOT tissue invasion. Treatment is surgical debridement of inspissated mucin plus topical or systemic corticosteroids. Systemic antifungals have a limited role (unlike invasive aspergillosis). It resembles allergic bronchopulmonary aspergillosis (ABPA) in the lungs.

Reference: BSACI 2024 – AFRS; ENT-UK 2023 – Fungal sinusitis