International Journal of Medical Laboratory Research (IJMLR)

THE UTILITY OF NASAL SECRETION CYTOLOGY IN DIAGNOSIS OF ALLERGIC FUNGAL SINUSITIS- A CASE REPORT

 

Geet Bhuyan, Abir Kumar Baruah, Projnan Saikia

​

ABSTRACT: INTRODUCTION-Allergic fungal sinusitis (AFS) is a condition commonly occurring in immunocompromised individual. It is commonly characterized by increase eosinophils and increased IgE. CASE DETAILS- A 48-year-old female presented with foul smelling discharge from right nostril and right nasal blockage for one year. A clinical diagnosis of right maxillary sinus polyp was given. CT scan revealed mucosal thickening in right maxillary wall with central area of hyper density and calcification. Nasal swabs were taken and subsequently stained with Pap and MGG stain. Smears revealed fungal hyphae and a provisional diagnosis of allergic fungal sinusitis was given.  The patient was operated and the diagnosis was confirmed on histology. DISCUSSION- AFS is a relatively incompletely understood entity with characteristic clinical, radiological and histopathological finding. Fungal elements can be detected from nasal discharge by means of cytology.  CONCLUSION- Nasal secretion cytology can be used as a preoperative as well as an intraoperative tool for or early rapid diagnosis of AFS.

KEYWORD: Nasal secretion cytology, Allergic fungal sinusitis, fungal hyphae

​

REFERENCES:

1. [1]. Katzenstein AL, Sale SR, Greenberger PA. Allergic Aspergillus sinusitis: a newly recognized form of sinusitis. J Allergy Clin Immunol. 1983; 72:89-93. 

2. [2]. Makihara S, Kariya S, Naito T, Matsumoto J, Okano M, Nishizaki K. Low incidence of allergic fungal rhinosinusitis in Japanese patients. Clinical Medicine Insights: Ear, Nose and Throat. 2019;12: 117955061987075. 

3. [3]. C Torres, JY Ro, AK el-Naggar, SJ Sim, RS Weber, AG Ayala. Allergic fungal sinusitis: a clinicopathologic study of 16 cases. Hum Pathol. 1996;27,8:793–9.

4. [4]. Gelardi M, Iannuzzi L, Quaranta N, Landi M, Passalacqua G. Nasal cytology: Practical aspects and clinical relevance. Clinical & Experimental Allergy. 2016;46,6:785–92. 

5. [5]. Hellings PW, Scadding G, Alobid I, Bachert C, Fokkens WJ, Gerth van Wijk R. Executive summary of European Task Force Document on diagnostic tools in rhinology. Rhinology journal. 2012;50,4:339–52.

6. [6]. Dykewicz MS, Rodrigues JM, Slavin RG. Allergic fungal rhinosinusitis. Journal of Allergy and Clinical Immunology. 2018;142,2:341–51. 

7. [7]. Schubert MS, Goetz DW. Evaluation and treatment of allergic fungal sinusitis. I. Demographics and diagnosis. J Allergy Clin Immunol. 1998;102,3:387-394.

8. [8]. Schubert MS, Goetz DW. Evaluation and treatment of allergic fungal sinusitis. II. Treatment and follow-up. J Allergy Clin Immunol. 1998;102,3:395-402. 

9. [9]. deShazo RD, Swain RE. Diagnostic criteria for allergic fungal sinusitis. J Allergy Clin Immunol. 1995;96,1:24-35.

10. [10]. Rane SR, Kadgi NV, Agrawal SA, Kavatkar AN. Nasal discharge cytology an important diagnostic method for allergic fungal sinusitis: report of three cases. J Clin Diagn Res. 2014;8,3:121-122.

11. [11]. Kuhn FA, Javer AR. Allergic fungal sinusitis: a four-year follow-up. Am J Rhinol. 2000;14,3:149-156.