Chronic granulomatous invasive fungal sinusitis: a review of the literature and report of a case atypical for the Balkan region

Milica Labus; Aleksandar  Perić; Jelena Sotirović; Biserka Vukomanović Djurdjević

doi:10.5937/afmnai40-37869

Milica Labus Klinika za otorinolaringologiju, Vojnomedicinska akademija https://orcid.org/0000-0002-0570-4176
Aleksandar Perić Klinika za otorinolaringologiju, Medicinski fakultet Vojnomedicinske akademije Univerziteta odbrane u Beogradu https://orcid.org/0000-0002-8453-7272
Jelena Sotirović Klinika za otorinolaringologiju, Medicinski fakultet Vojnomedicinske akademije Univerziteta odbrane u Beogradu https://orcid.org/0000-0001-9818-0668
Biserka Vukomanović Djurdjević Institut za patologiju, Medicinski fakultet Vojnomedicinske akademije Univerziteta odbrane u Beogradu https://orcid.org/0000-0001-5031-6757

DOI: https://doi.org/10.5937/afmnai40-37869

Keywords: Granuloma; Inflammation; Mycoses; Nasal Surgical Procedures; Sinusitis; Voriconazole

Abstract

Introduction: Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is an extremely rare form of invasive fungal sinusitis. The disease has a long-lasting and indolent course, so the invasion and destruction in the sinonasal and adjacent regions is progressing slowly. This disease has been reported primarily in Middle East, North Africa, India and Pakistan; however, it is very rare in western countries. It is primarily caused by Aspergillus flavus.

Methods: We present a case of a 40-year-old man with diagnosis of CGIFRS. To our knowledge, this is the first case of CGIFRS presented in Serbia. In addition, we review the literature concerning this rare form of fungal sinusitis, especially for the Balkan region.

Results: The patient was successfully treated with a combination of surgery and postoperative medical therapy with voriconazole. Histopathological examination was necessary for final diagnosis. The finding of granulomatous response along with fibrosis and strong inflammatory infiltrate was typical for the CGIFRS.

Conclusion: Although we reported an extremely rare case of fungal sinusitis for the Balkan region, it is important to suspect on it in all cases where chronic inflammation of the paranasal sinuses does not respond to conventional treatment.

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