J Rhinol.  2016 Nov;23(2):119-123. 10.18787/jr.2016.23.2.119.

Chronic Invasive Sinonasal Mucormycosis; A Rare Disease Entity

• Kim D
• Kim JW
• Ahn SJ
• Hong SL

• KMID: 2361326
• DOI: http://doi.org/10.18787/jr.2016.23.2.119

Abstract

Mucormycosis is a rare invasive fungal infection of the nose and paranasal sinus, which often has an acute fulminant course and distinctive clinical findings. It usually occurs in diabetics or immunocompromised patients and shows rapid progression with a high mortality rate. Slow, silent progression is a highly unusual presentation of this disease. Herein, we report a case of mucormycosis with a chronic course of invasion into the hard palate and the maxillary sinus.

Keyword

Mucormycosis; Chronic; Sinusitis; Hard palate; Diabetes mellitus

MeSH Terms

Diabetes Mellitus
Immunocompromised Host
Maxillary Sinus
Mortality
Mucormycosis*
Nose
Palate, Hard
Rare Diseases*
Sinusitis

Figure

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  Fig. 1. Preoperative local findings. Endoscopic findings of right nasal cavity showed (A) edematous inferior turbinate with pus, and (B) right hard palatal bulging and growing granulomatous tissue from extraction area of molars.

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  Fig. 2. Preoperative imaging studies. Preoperative computed tomography revealed soft tissue density and bony destruction of the right maxillary sinus and mucosal abnormalities of the right inferior turbinate and the hard palate (A and B). Magnetic resonance images showed mass-like lesion along with internal necrosis at the right maxillary sinus, nasal cavity and hard palate (C and D).

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  Fig. 3. Pathologic findings of the specimens (hematoxylin & eosin stain). Extensive tissue necrosis with granulomatous inflammation (center) was displayed under the overlying respiratory epithelium, which was accompanied with bone destruction (left lower) (H&E, ×12.5) (A). At high magnification, the entrapped necrotic bony spicules were observed in the edge of the granuloma (H&E, ×100) (B). Fungal organisms, showing broad ribbon-like, non-septate hyphae with branching at right angles, morphologically compatible with mucormycosis were found with angioinvasion (H&E, ×200, ×400, respectively) (C and D).

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  Fig. 4. Postoperative findings of the patient. Nasal endoscopic examination (A) and computed tomography (B and C) 5 months after treatment showed a well-healed mucosa without exposure of dead bone and oroantral fistula.

Reference

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