Case report:
A 55-year-old female was referred to our office for a three-month left nasal obstruction concomitant with purulent nasal discharge and facial algia non responding to many courses of oral antibiotics. Her medical history included diabetes mellitus. The endoscopic exam revealed a purulent rhinorrhoea and a hypertrophic middle turbinate with granulomatous mucosa, filling the nasal cavity repressing the septum. A computed tomography scan of paranasal sinuses showed a heterogeneous lesion of the left Middle turbinate focally hyperdense filling the nasal cavity and repressing the septum. Ipsilateral Maxillary, ethmoid and frontal sinuses were entirely filled. No sinus wall erosion was noted (figure 1). Fungal sinusitis was suspected. Our patient underwent a functional endoscopic sinus surgery consisting in a left middle turbinoplasty, a left middle meatotomy, a left functional endoscopic ethmoidectomy and sphenoidotomy. However, the presence of white lumps intraoperatively was in favour of actinomycosis (Figure 2). Histopathology confirmed indeed the latter diagnosis given the presence of actinomycetes (Figure 3). Thus, she received a four-week-oral amoxicillin- clavulanic acid cure (80 mg/kg/day). The clinic and endoscopic six-month follow-up did not reveal any sign of relapse.