Invasive or Allergic Fungal Sinusitis?-Reply

Yahya Ismail, MD; Edward L. Arsura, MD
Arch Intern Med. 1994;154(7):815-819. doi:10.1001/archinte.1994.00420070145018.
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In response to Busch's letter, we believe that our patient's initial presentation was allergic fungal sinusitis.1 However, invasive fungal sinusitis supravened, as evidenced by the multiple recurrences and the extent of soft-tissue invasion and the bony destruction that is shown in Figure 1 in our article. In addition, the aforementioned features are in accordance with the definition of invasive sinusitis, as described in the literature.2-4 Furthermore, there have been numerous cases in the literature of invasive sinusitis characterized by tissue invasion resulting in bony destruction with extension into the orbit and/or intracranially, which occur in both immunocompetent and immunocompromised hosts.4

There is considerable support in the literature for the use of antifungal therapy, specifically amphotericin B, in both recurrent and invasive fungal sinusitis.5 Different treatment modalities have been tried alone or in conjunction with surgical resection, but there is not enough evidence that they are effective;


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