A Case of Allergic Fungal Rhinosinusitis Associated With Abducens Nerve Palsy

Kenzo Tsuzuki, Kengo Hashimoto, Ken Okazaki, Kazutaka Kuroda and Masafumi Sakagami

Department of Otolaryngology - Head and Neck Surgery, Hyogo College of Medicine, Japan

^*Correspondance to: Kenzo Tsuzuki 

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Abstract:

Background: Allergic Fungal Rhinosinusitis (AFRS) is characterized by Chronic Rhinosinusitis (CRS) with nasal polyps (CRSwNP), type I and III hypersensitivity reaction, production of allergic mucin with abundant eosinophils, and non-invading fungi. Ophthalmic complications due to cranial neuropathies are uncommon in AFRS. A case of AFRS with abducens nerve paralysis is reported.Patient Description: A 66-year-old man presented with worsening diplopia and nasal obstruction. Ophthalmologists diagnosed left abducens nerve paralysis. Edematous and polypoid mucosa with viscous discharge was observed in the left middle and superior nasal meatuses. Blood examination showed hyperglycemia, eosinophilia, and antigen-specific IgE positive to Aspergillus. Opacification of a high-density area with sphenoid bony deficiency was seen on computed tomography and iso- and low intensities were observed on T1- and T2- weighted magnetic resonance imaging in the left maxillary, posterior ethmoid and sphenoid sinuses. Left Endoscopic Sinus Surgery (ESS) was performed urgently under general anesthesia. Polypoid mucosa with viscous contents was observed in the maxillary, posterior ethmoid and sphenoid sinuses during ESS. Histopathological examination of the sphenoid sinus showed Aspergillus in the contents and marked eosinophilic infiltration without fungal infiltration into the mucosa. Consequently, the definitive diagnosis was AFRS. At postoperative 3 months, ophthalmologists diagnosed the diplopia as cured. Currently 6 months after surgery, there is no evidence of suspected recurrence or exacerbation.Conclusion: AFRS should be suspected when nasal polyposis with viscous discharge and cranial nerve paralysis are seen, and it should be carefully treated surgically.

Keywords:

Allergic Fungal Rhinosinusitis (AFRS); Abducens nerve paralysis; Endoscopic Sinus Surgery (ESS)

Cite the Article:

Tsuzuki K, Hashimoto K, Okazaki K, Kuroda K, Sakagami M. A Case of Allergic Fungal Rhinosinusitis Associated With Abducens Nerve Palsy. Ann Clin Case Rep. 2018; 3: 1510.