A 47-year-old patient, with no major morbid history. At 27 years of age, a foreign body (certificate) was removed from the right nostril.
The patient presented with a clinical picture of approximately five years of evolution consisting of recurrent posterior discharge, mucopurulent with remnants helium, without response to antibacterial therapy.
Physical examination revealed right nasal septum deviation, with no other pathological findings.
The imaging study with x-rays of paranasal cavities showed opacity of the right maxillary sinus and CT of paranasal cavities was informed as: "right maxillary sinus occupied by material with density of soft tissue ipsilateral pocket erofundus, presence of bony canal ioib
Naso-fibrobronchoscopy detected a polypoid lesion in the right nasal fossa at the level of the middle meatus, posteriorly, without reaching the choana, vascularized.
The nasopharynx showed normal appearance.
The oropharynx and hypopharynx were normal.
Highlighted laboratory tests: haemoglobin blood count 12.5 g/dl, white blood cells 4,500 cleavage/mm3 (eosinophilisates 58%, lymphocytes monocytes 8%), platelets/mm3, segmented VHS 31%.
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Surgery was performed to remove the sinus content using the Caldwell-Luc technique, with an incision through the right upper alveolar ridge and opening of a bone window in the maxillary sinus, giving rise to large amount of secretion.
No lesions of the right nasal fossa or anomalous tissue were found in the choanae or nasopharynx.
The patient was successfully treated postoperatively.
The material obtained was sent for microbiological and histopathological study.
The anatomopathological report was: "chronic erosive sinusitis, presence of philation with septate and branched hyphae, suggestive ofAspergillus sp.
No fungal invasion or atypical lesions were observed.
A rapid-growth philosophies coffee was isolated at 25 °C, with colonies of cotton-yellow texture, cream-coloured to cinnamon coffee, slightly irregular edges.
Microscopically, it was observed the presence of hyaline hyphae septate with straight conidiophores of variable length with generation in its distal portion of unicellular oval aneloconidia and asper shape.
Identification was confirmed in the Laboratory of Mental Disorders Institute of Biomedical Sciences (ICBM), Faculty of Medicine, University of Chile.
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Due to its long symptomatic evolution and the suspicion of a polypoid lesion of invasive type, antifungal treatment with 200 mg of itraconazole was initially discontinued every 12 hours, with no evidence of alteration in the liver tests being suspended or not.
The clinical evolution at three months was satisfactory; a new CT of paranasal cavities showed its total pneumatization and symmetry, signs of right medial maxillectomy and marginal inflammatory elements of the right maxillary sinus hydro-aerial.
