Case report
63-year-old immunocompetent man, with no comorbidities, has as main
complaint pain, in the forehead, predominantly left, with a stabbing
character, starting two months ago, with no evolution. During this
period, he used antibiotics, anti-inflammatories, and topical and
systemic corticosteroids, with no improvement in his condition.
The initial hypotheses that guide the request for the first exams were
nasal tumors, recurrent acute and chronic rhinosinusitis.No
abnormalities in blood and serological tests. The endoscopic examination
of the nasal cavity revealed mucosal edema with purulent secretion of
the ostiomeatal complex. CT scan of the paranasal sinuses identified
veiling of the frontal sinus with microcalcifications, hyper-attenuating
areas, associated with bone wall sclerosis, suggestive of fungal bolus
(Figures 2 and 3). As these CT findings are typical of a fungal ball,
there were no differential diagnoses.
The patient underwent maxillary sinusectomy, wide ethmoidectomy and
frontal sinusectomy like DrafIIa, with complete removal of the lesion
(Figure 4). The microbiological examination showed sparse fragments of
mucosa covered by respiratory epithelium, with edema of the lamina
propria and a marked inflammatory infiltrate (lymphocytes, neutrophils,
histiocytes and plasma cells). Abundant septate fungal hyphae were
dichotomized at an acute angle, compatible with Aspergillus sp .,
with no signs of malignancy in the present material and the search for
fungi by Grocott stain was positive. Biopsy of the healthy frontal sinus
mucosa confirmed negative non-invasive fungal ball.
There were no intraoperative and postoperative complications. Currently,
the patient has an 8-month follow-up and complete improvement of the
condition.