Les sinusites aspergillaires : à propos de trois cas dans l’hôpital de Sfax, Tunisie

Abstract

Among the non invasive fungal sinus diseases, fungus ball has been increasingly reported and large published series have allowed better characterization of the disease and the treatment strategies in immunocompetent people. We report three cases of aspergillosis sinusitis diagnosed in our hospital. This fungal ball occurred in two men and one immunocompetent woman with a chronic sinusitis. Dental care by zinc oxide was found in one patient. The endoscopy and computed tomography have viewed training polypoides bridging the maxillary sinus only in the first case and the frontal sinus and ethmoid in the second case. A multi location has been found in the third case with achieving the ethmoid on both sides of the right maxillary sinus, right frontal sinus and sphenoidal sinus. The mycological and anatomopathological exam showed fungal hyphae but not invasion in all cases. Aspergillus flavus has been isolated in the third case. All the patients had only surgical treatment without antifungal. No recurrence was noted. Discussion Endodontic treatment on maxillary teeth with zinc constitutes a strong risk factor for sinus fungus ball. However, the clinical symptoms may be expressive particularly in multisinus localisation, rarely reported. Functional endoscopic sinus surgery is the gold standard for treatment and antifungal therapy is unnecessary.