Rare Presentation of Fungal Sinusitis with Hypertelorism

Introduction: Allergic fungal sinusitis is a well-recognized form of fungal sinusitis first described 20 years ago. In as much as this entity does not present well-defined diagnostic criteria, many questions concerning its physiopathology and treatment rise.

Objectives: This article aims to present a case of allergic fungal sinusitis that caused hypertelorism in a 16-year-old boy.

Resumed report: A 16-year-old Afro-American male patient (P. H. S.) has been presenting greenish nasal discharge, holocranial headache, and progressive ocular hypertelorism for the last 2 years. On clinical examination, an important lateralization of the eyeball has been observed. The rhinoscopy revealed dark greenish secretion and nasal mucosa with polypoid degeneration. Computed tomography scan of the sinuses showed swelling of frontal and ethmoid cells as well as bone destruction of the lamina papyracea and the anterior wall of the frontal sinus. It has also been noted a significant increase in interocular distance. The surgery comprised bilateral ethmoidectomy and bilateral maxillary, frontal, and sphenoid sinus sinusotomy. The fungal culture performed with intraoperative material showed penicillium sp and fungi negro.

Conclusion: Allergic fungal sinusitis should be considered in all atopic patients with chronic sinus disease and should be investigated especially in those reporting discharge of thick and dark mucus plugs, and/or if extensive and tomographic features were noticed.