Asad Qayyum, Naveed Hasan Chaudhary, Danyal Rashid.
Fungal Sinusitis.
Pak J Pathol Jan ;12(4):37-9.

An eleven year old girl presented with history of progressive nasal obstruction on the right side for about a year and a half. She also complained of swelling of the right eye for the last one year. There was no history of epistaxis. Her Computerized Tomographic (CT) Scan (Orbit and Paranasal sinuses) states, “There is a soft tissue density enhancing lesion in the region of right maxillary sinus and right nasal cavity. The mass is eroding the superomedial aspect of right Maxillary sinus. Anterior and lateral walls of the sinus are thinned out and expanded. The mass is extending and eroding into the ethmoidal air cells, right sphenoidal sinus and frontal sinus. Erosion of medial wall of right orbit with mild displacement of orbital contents is seen. No intracranial extension is noted". The histopathology report of the biopsy specimen, comments, "Granulation tissue with acute on chronic non specific inflammation". She underwent sinus endoscopy and lateral rhinotomy for the removal of the mass. This pathological report also depicted nonspecific inflammation. Lately, she reported after a lapse of about one year with persistent complaints. ENT examination revealed a lateral rhinotomy scar and a glistening polypoidal mass right nasal cavity. Visual acuity right eye was 6/12 unaided, improving to 6/9 with pinhole and glasses and 6/6 unaided left eye. Right axial proptosis of 5 mm was present. A firm mass involving the right lacrimal fossa, with extension above and below, was present. Posterior extent of the mass was not palpable. Furthermore, orbital rim was obliterated in this area. Repeat biopsy of the nasal mass was performed. Keeping in mind the inconclusive previous histopathology reports and the strong suspicion of fungal sinusitis, the specimen was sent to two different laboratories. Only one of the two reports was suggestive of fungal infection. Diagnosis: Nasal polyp, largely necrotic tissue with fungal septate hyphae. The polypoidal mas was removed by External Ethmoidectomy and Caldwell-Luc`s operation. The operation specimen was negative for presence of fungus on histopathology and culture. Based on the previous positive histopathology report, she was put on oral antifungal Itraconazole. Her response to the drug is remarkable and she is symptom free for a period of four months after surgery. There is no clinical evidence of recurrence of the disease either.

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