An immunocompetent young adult has chronic unilateral proptosis. CT shows expansile heterogeneously hyperdense sinus opacification with smooth bony remodelling; MRI shows central T2 signal loss. There is nasal polyposis and eosinophilic mucin but no tissue invasion. What is the best management?
The pattern supports allergic fungal rhinosinusitis, a non-invasive inflammatory disease. Surgery removes obstructive allergic mucin and restores access for topical corticosteroid therapy; recurrence surveillance is essential.
A. Endoscopic clearance and ventilation followed by topical anti-inflammatory treatment and surveillance: The pattern supports allergic fungal rhinosinusitis, a non-invasive inflammatory disease. Surgery removes obstructive allergic mucin and restores access for topical corticosteroid therapy; recurrence surveillance is essential.
B. Radical maxillectomy for invasive malignancy: Smooth remodelling and absence of tissue invasion do not justify oncological resection.
C. Systemic amphotericin as sole treatment: This is not acute invasive fungal disease, and medication alone does not clear impacted mucin.
D. No treatment because the patient is immunocompetent: Non-invasive disease can still expand, erode bone and threaten the orbit.
E. Orbital exenteration: There is no invasive orbital fungal necrosis or malignant invasion.
If biopsy demonstrated angioinvasion with necrosis in a neutropenic patient, urgent radical debridement plus systemic antifungal treatment would be required.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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