Abstract
Introduction: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture. Case Report: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voriconazole and surgical debridement. Possible clinical manifestations, diagnostic imaging techniques and treatment used are discussed. Since the introduction of voriconazole, there have been several reports of patients with invasive aspergillosis who responded to treatment with this new antifungal agent. Conclusions: We report the importance of early diagnosis and selection of an appropriate antifungal agent to achieve a successful treatment. Key words:Invasive aspergillosis, voriconazole, fungal sinusitis, antifungal agent, open sinus surgery.
Highlights
IntroductionThe term “Aspergillosis” refers to an illness due to allergy, airway or lung invasion, cutaneous infection, or extrapulmonary dissemination caused by species of Aspergillus
Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; its incidence has seen substancial growth over the past 2 decades
Suspicion can arise in cases of purulent rhinosinusitis which do not respond to two or more courses of antibiotics, and on the basis of radiological features
Summary
The term “Aspergillosis” refers to an illness due to allergy, airway or lung invasion, cutaneous infection, or extrapulmonary dissemination caused by species of Aspergillus. The non-invasive forms are allergic sinusitis and aspergilloma; this infection leads to destruction of the sinus mucosa and bone atrophy. CT scan revealed a soft tissue density mass in the left maxillary sinus with bone erosion of the anterolateral wall, suggestive of a malignancy (Fig. 2). With this suspicion, we decided to perform a left Caldwell-Luc procedure under local anaesthesia to biopsy the mass and sent for histologic analysis. After 4 months of oral administration of voriconazole, the patient remained well and CT scan showed no radiological evidence of disease, we decided to interrupt the treatment. To this date the patient is asymptomatic and shows no clinical or radiographic evidence of recurrent disease
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