Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis

This case report presents the clinical evaluation of an 11-year-old boy with a unilateral polypoid nasal mass causing nasal obstruction, facial asymmetry, and intermittent epistaxis. His clinical picture raised concerns of a juvenile nasopharyngeal angiofibroma; however, further imaging and histopat...

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Main Authors: Tessa K. Suttle, Johan Grobbelaar, Ursula Lesar, Razaan Davis, Leon Janse van Rensburg, Shaun E. Adam
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:Sinusitis
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Online Access:https://www.mdpi.com/2673-351X/9/1/10
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author Tessa K. Suttle
Johan Grobbelaar
Ursula Lesar
Razaan Davis
Leon Janse van Rensburg
Shaun E. Adam
author_facet Tessa K. Suttle
Johan Grobbelaar
Ursula Lesar
Razaan Davis
Leon Janse van Rensburg
Shaun E. Adam
author_sort Tessa K. Suttle
collection DOAJ
description This case report presents the clinical evaluation of an 11-year-old boy with a unilateral polypoid nasal mass causing nasal obstruction, facial asymmetry, and intermittent epistaxis. His clinical picture raised concerns of a juvenile nasopharyngeal angiofibroma; however, further imaging and histopathological evaluation ultimately confirmed the diagnosis of allergic fungal rhinosinusitis (AFRS). Although this patient was younger in age than those traditionally associated with AFRS, classical features present on both computed tomography (CT) and magnetic resonance imaging (MRI) aided in his diagnosis and management. This case underscores the importance of a comprehensive diagnostic approach when evaluating unilateral sinonasal masses in paediatric patients, specifically in atypical presentations where the diagnosis of AFRS may not initially be considered. It highlights the critical role of imaging as a diagnostic tool, specifically CT and MRI, which were pivotal in the work-up and management of this case. Additionally, the need for caution during biopsies of sinonasal masses in children is emphasised, as there is potential for catastrophic bleeding in vascularised masses such as juvenile nasopharyngeal angiofibroma. This case demonstrates that AFRS can occur in younger children, highlighting the need to include this in the differential diagnosis, even in patients outside of the traditionally described age group.
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series Sinusitis
spelling doaj-art-1bc4083e48ec49dfa4c50deb7372b9da2025-08-20T03:27:43ZengMDPI AGSinusitis2673-351X2025-05-01911010.3390/sinusitis9010010Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal RhinosinusitisTessa K. Suttle0Johan Grobbelaar1Ursula Lesar2Razaan Davis3Leon Janse van Rensburg4Shaun E. Adam5Division of Otorhinolaryngology, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town 7505, South AfricaDivision of Otorhinolaryngology, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town 7505, South AfricaDepartment of Medical Imaging and Clinical Oncology, Division Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town 7505, South AfricaDepartment of Medical Imaging and Clinical Oncology, Division Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town 7505, South AfricaDepartment of Medical Imaging and Clinical Oncology, Division Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town 7505, South AfricaDivision of Otorhinolaryngology, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town 7505, South AfricaThis case report presents the clinical evaluation of an 11-year-old boy with a unilateral polypoid nasal mass causing nasal obstruction, facial asymmetry, and intermittent epistaxis. His clinical picture raised concerns of a juvenile nasopharyngeal angiofibroma; however, further imaging and histopathological evaluation ultimately confirmed the diagnosis of allergic fungal rhinosinusitis (AFRS). Although this patient was younger in age than those traditionally associated with AFRS, classical features present on both computed tomography (CT) and magnetic resonance imaging (MRI) aided in his diagnosis and management. This case underscores the importance of a comprehensive diagnostic approach when evaluating unilateral sinonasal masses in paediatric patients, specifically in atypical presentations where the diagnosis of AFRS may not initially be considered. It highlights the critical role of imaging as a diagnostic tool, specifically CT and MRI, which were pivotal in the work-up and management of this case. Additionally, the need for caution during biopsies of sinonasal masses in children is emphasised, as there is potential for catastrophic bleeding in vascularised masses such as juvenile nasopharyngeal angiofibroma. This case demonstrates that AFRS can occur in younger children, highlighting the need to include this in the differential diagnosis, even in patients outside of the traditionally described age group.https://www.mdpi.com/2673-351X/9/1/10allergic fungal rhinosinusitisunilateral sinonasal masspre-adolescentepistaxis
spellingShingle Tessa K. Suttle
Johan Grobbelaar
Ursula Lesar
Razaan Davis
Leon Janse van Rensburg
Shaun E. Adam
Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis
Sinusitis
allergic fungal rhinosinusitis
unilateral sinonasal mass
pre-adolescent
epistaxis
title Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis
title_full Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis
title_fullStr Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis
title_full_unstemmed Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis
title_short Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis
title_sort approach to a unilateral sinonasal mass in a pre adolescent male an unusual presentation of allergic fungal rhinosinusitis
topic allergic fungal rhinosinusitis
unilateral sinonasal mass
pre-adolescent
epistaxis
url https://www.mdpi.com/2673-351X/9/1/10
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