A 26-year-old immunocompetent Central African patient who reported having undergone rhinoseptoplasty 2 years ago as the only personal history of interest.
She complained of intermittent pain in the right maxillary region of months of evolution and mild purulent rhinorrhea.
In the anamnesis, the patient reported feeling of occupation of the right nasal fossa and recurrent headaches.
Physical examination did not yield any relevant findings, since rhinorrhea was not observed at the time of its performance.
No masses or alterations were found in the maxillary region.
No fistulas were observed in any location.
After anamnesis and physical examination, orthopantomography and radiography of sinus mucosa were requested, in which several radiopaque images of metallic density in the right maxillary sinus could be observed, accompanied by inflammation.
Facial CT was requested.
1.
CT images show in greater detail the presence of a cluster of radiopaque images at the ground level of the right maxillary sinus, associated with a chronic inflammatory reaction of the surrounding mucosa.
1.
The imaging findings were suspicious for a foreign body lodged in the sinus.
We reinterrupted the patient who denied inhalation of any type of substance.
With the diagnostic suspicion of sinus fungal occupation we approached the right maxillary sinus through an intraoral Cadwell-Luc approach.
The accumulated material was drained and the affected mucosa was removed, including several formations of fibroelastic consistency and purulent color, which as a whole measure 3.5 cm in maximum dimension.
Antrostomy was performed and drainage placed on the right nasal fossa.
The patient had an uneventful postoperative period and was discharged 24 h after surgery.
Although the results of microbiological studies were negative, with no growth of any microorganism in them, the AP study revealed the presence of a sinus mucosa branch with signs of chronic inflammation adjacent to a large fungal ball with Aspergillus hyphae.
Due to the presence of atypical sinus mucosa and systemic amphotericin B, it was decided to readmit the patient for antibiotic and antifungal treatment IV agreed with the infectious diseases service (amoxicillin/acid).
The patient was discharged after 5 days of IV treatment to continue oral treatment with voriconazole on an outpatient basis.
There were no complications or recurrences in subsequent reviews in a 10-year follow-up.
