Allergic fungal sinusitis症例  [in Japanese] A Case Report of Allergic Fungal Sinusitis Caused by Penicillium sp.and Cladosporium sp.  [in Japanese]

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Author(s)

    • 飯田 誠 IIDA Makoto
    • 東京慈恵会医科大学耳鼻咽喉科学教室 Department of Otorhinolaryngology, the Jikei University School of Medicine
    • 野原 修 NOHARA Osamu
    • 東京慈恵会医科大学耳鼻咽喉科学教室 Department of Otorhinolaryngology, the Jikei University School of Medicine
    • 春名 眞一 HARUNA Shinniti
    • 東京慈恵会医科大学耳鼻咽喉科学教室 Department of Otorhinolaryngology, the Jikei University School of Medicine
    • 森山 寛 MORIYAMA Hiroshi
    • 東京慈恵会医科大学耳鼻咽喉科学教室 Department of Otorhinolaryngology, the Jikei University School of Medicine

Abstract

今回我々はペニシリウムおよびクラドスポリウムによるAllergic fungal sinusitis症例を経験したので報告する.<BR>症例は57歳の男性. (1) CT scanにて慢性副鼻腔炎の所見, (2) 既往症にスギ花粉症を3年前より発症, (3) ペニシリウム, クラドスポリウム皮膚反応試験陽性, (4) 同真菌の特異的IgE値上昇, (5) 総IgE値上昇, (6) 好酸球浸潤の著しい鼻ポリープ, (7) 細胞診にてアレルギー性ムチンの証明, (8) 細胞診にて真菌菌糸の証明, (9) 真菌培養にてペニシリウム, クラドスポリウム検出, などの診断基準を満たしペニシリウムおよびクラドスポリウムによるAFSと診断した. 治療は内視鏡下鼻内手術を施行. 術後4週目に鼻ポリープの再発をきたしたが, ステロイドの内服およびステロイドと抗真菌剤 (フルコナゾール) のネブライザー療法にて改善し有効であった. 病態の改善とともに, 総IgE値, 特異的IgE値の低下と末梢血好酸球数の減少を認めた. 抗原誘発テストを施行し, 即時相は陽性であった. IgE抗体を介するI型アレルギー反応がAFSの病態に関与していると考えた.

We report a case of allergic fungal sinusitis (AFS) caused by <I>Penicillium sp.</I> and <I>Cladosporium sp.</I> in a 57-year-old man satisfying the following diagnostic criteria: (1) chronic rhinosinusitis revealed by computed tomographic scan, (2) Japanese cedar pollinosis for 3 years, (3) positivity for <I>Penicillium sp.</I> and <I>Cladosporium sp.</I> by a skin test, (4) increased immunoglobulin E (IgE) specific to these fungi, (5) increased total IgE, (6) nasal polyps with severe eosinophilic invasion, (7) allergic mucin revealed by histopathological examination, (8) fungal hyphae revealed by histopathological examination and (9) detection of <I>Penicillium sp.</I> and <I>Cladosporium sp.</I> revealed by fungi culture. The patient was treated by endoscopic sinus surgery. Four weeks after surgery, nasal polyps recurred, but his condition was improved by oral administration of steroids and nebulizer treatment with steroids and fluconazole. Total IgE, specific IgE and eosinophil count in the peripheral blood decreased, apparently reflecting this improvement. After obtaining the patient's consent, we conducted an allergen provocation test, which is as highly diagnostic as a skin test, to test for an antigen causing type I hypersensitivity. The immediate phase response was positive, indicating that type I hypersensitivity intermediated by IgE was involved in AFS.

Journal

  • Nippon Jibiinkoka Gakkai Kaiho

    Nippon Jibiinkoka Gakkai Kaiho 104(12), 1147-1150, 2001-12-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

References:  9

Cited by:  6

Codes

  • NII Article ID (NAID)
    10008095290
  • NII NACSIS-CAT ID (NCID)
    AN00191551
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    00306622
  • Data Source
    CJP  CJPref  J-STAGE 
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