Possible allergic fungal sinusitis

A 55-year-old African American man was referred by his otolaryngologist for further evaluation and treatment of probable "allergic fungal sinusitis" (AFS). The patient had a long history of chronic rhinosinusitis, although neither he nor his first-degree relatives had rhinitis, eczema, or asthma. He reported 3 previous endoscopic sinus surgeries spaced roughly at 3-year intervals. The recent revision sinus surgery leading to this referral was preceded by symptoms of nasal obstruction. A sinus computed tomogram showed postsurgical changes, complete opacification of the paranasal sinuses, and obstruction of the remaining components of the osteomeatal complex (Fig 1).

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