Preoperative steroids confuse the diagnosis of allergic fungal sinusitis
Preoperative steroids confuse the diagnosis of allergic fungal sinusitis
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DOI：
10.1016/s0091-6749(98)70211-8
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发表时间：
1998-01-01
影响因子：
14.2
通讯作者：
Ballas, ZK
中科院分区：
文献类型：
--
作者：
Graham, SM;Ballas, ZK
报告了一例来自美国爱荷华州的39岁男性病例[未给出日期]，3个月前有鼻窦手术史，出现充血和溢液症状复发。从病人身上培养出烟曲霉菌。鼻内窥镜检查发现右侧息肉样变化和感染。计算机断层扫描显示单侧息肉样改变，多发性窦混浊，骨性扩张和蝶窦内的高密度区。患者术前立即接受泼尼松治疗5天。进行蝶窦切开术，组织学检查从筛窦和中鼻道取出的厚糊状物质显示菌丝与曲霉菌一致。诊断为蝶窦真菌球，未计划进一步治疗。术后2周症状复发，内镜检查和活检标本病理检查诊断为变应性真菌性鼻窦炎。患者对随后的皮质激素治疗反应迅速。结论：鼻息肉病的术前类固醇治疗混淆了AFS的后续组织学诊断。
A case is reported in a 39-year-old man from Iowa, USA [date not given], with a history of sinus surgery 3 months earlier, who presented with a relapse of symptoms of congestion and rhinorrhoea. Cultures from the patient had grownAspergillus fumigatus. Endoscopic examination of the nose revealed right-sided polypoid changes and infection. Computed tomography demonstrated unilateral polypoid changes, multiple sinus opacification, bony expansion and areas of hyperattenuation within the sphenoid sinus. The patient was treated with prednisone for 5 days immediately preoperatively. A sphenoidotomy was performed and histological examination of thick, pasty material removed from the ethmoid sinus and middle meatus showed hyphae consistent withAspergillus. A diagnosis of sphenoid fungus ball was made and no further treatment was planned. Symptoms recurred 2 weeks after surgery and allergic fungal sinusitis was diagnosed from endoscopy and pathological examination of biopsy samples. The patient responded promptly to subsequent corticoid treatment. It is concluded that the preoperative steroid treatment of nasal polyposis confused the subsequent histological diagnosis of AFS.