Abstract
Invasive fungal infections are commonly associated with some form of immunosuppression. On the nasal epithelial surface, Aspergillus flavus, under favorable conditions, can aggressively breach multiple cell lines invading the local tissues. We present the case of a 35-year-old woman with granulomatous invasive Aspergillus flavus infection involving the nasal sinuses and the brain. Antifungal agents administered in the previous episodes contained the infection; however, the infected site evolved over time surrounded with calcified tissues in the left maxillary sinus. The current infection involved the other side of the maxillary sinus and extended to the orbital cavity eroding the parts of the skull and retro-orbital structures and was treated with a long course of isavuconazole therapy.
Highlights
Fungal colonization of nasal air passages is common among humans with frequent exposure to the Aspergillus flavus fungal conidia from the environment
An extreme high exposure to Aspergillus fungal conidia can promote the fungal infection in an immunocompetent host.[2]
The transition to infect the host depends on the host immune status and nasal tight junction breach, which enables the hematogenous access to the fungi
Summary
Fungal colonization of nasal air passages is common among humans with frequent exposure to the Aspergillus flavus fungal conidia from the environment. There was an additional left maxillary sinus mass measuring 4 cm with bone destruction. A 35-year-old Indian woman presented at our emergency department with left facial pain and swelling (Figure 1) for 2 months associated with intermittent frontal headache for the past 4 months. She had left nasal polyps that were removed twice in the years 2002 and 2011. She had an episode of aspergillosis of the left maxillary sinus invading the left frontal lobe, which was removed surgically in the year. The maxillary sinus mass revealed septate hyphae with dichotomous branching Aspergillus (Figure 7).
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