Chronic invasive fungal granulomatous rhino-sinusitis: a case report with review of literature

Abstract

Fungal Rhino-Sinusitis (FRS) is a relatively uncommon entity. The chronic invasive granulomatous form of FRS (FGRS) is a slowly progressive form of fungal infection characterized by chronic granulomatous process with a time course of longer than 12 weeks. The aim of this report is to draw the attention of colleagues to the clinical presentation and histopathological diagnosis of FGRS of the paranasal sinuses, as differential diagnosis in lesions of the maxillofacial region. We present a 30-year-old Nigerian undergraduate who had a four-year history of right nasal blockage. He also presented with a two-year history of proptosis of the right eye. Clinical and radiological findings were reported to be consistent with nasopharyngeal tumour. A trans-nasal biopsy was, initially, histologically, diagnosed as chronic granulomatous inflammation However, after a second opinion, at our centre, the granulomatous lesion was confirmed. Periodic Acid Schiff (PAS) and Gomori Methenamine Silver (GMS) stains showed presence of numerous septate fungal hyphae, within the giant cells and extracellularly. An assessment of FGRS was made. The patient was commenced on voriconazole, and there was a dramatic regression. Fungal infection should be considered in patients with chronic sinusitis and, if they present late with, orbital apex syndrome. If diagnosed and treated early, there is a rapid response rate. Effective collaboration between the Surgeon, Radiologist, Microbiologist and Histopathologist will ensure early diagnosis.

Keywords: Invasive Fungal Granulomatous Rhino-Sinusitis, PAS, GMS, Naso-Pharyngeal Tumor