Allergic Fungal Sinusitis with Bilateral Optic Neuropathy

Abstract

Introduction Allergic Fungal Rhinosinusitis (AFRS) is characterized by an inflammatory response to a non-invasive fungus which leads to sinus obstruction. Ophthalmic manifestations of AFRS are rare but can be of grave consequence. Case Report A 22-year-old female patient presented with a 5-day history of headache and decreased vision in both eyes (right- perception of light; left-6/18), along with a past history of nasal blockage and recurrent rhinorrhoea. She had thick viscid mucous secretion with polyposis in bilateral nasal cavities. Computed tomography showed pansinusitis with heterogenous opacification and polypoidal mucosal hypertrophy. Bony erosion was seen in bilateral orbital apices with oedematous optic nerves. MRI was suggestive of bilateral optic neuritis. Patient underwent emergency surgical debridement via endoscopic sinus surgery. Histopathological examination of the specimen showed cellular debris, eosinophilic prominence and numerous Charcot-Leyden crystals, with presence of branched septate fungal hyphae. Fungal culture grew Aspergillus flavus. Patient was treated with steroids (injectable followed by oral in gradually tapering doses). Over a period of 3 months vision returned to normal. Conclusion Vision loss is a rare complication of AFRS and constitutes an emergency. Prompt treatment with surgical debridement and corticosteroids is essential for reversal of visual complications.

Keywords

• Allergic Fungal Rhinosinusitis
• Optic Neuropathy