S Chavan Shrinivas, Bhople K S, Deshmukh Sunil D, V Jain Prateek, Sonavani Mangala
Department of Otorhinolaryngology, Government Medical College, Aurangabad, India.
Department of Pathology, Government Medical College, Aurangabad. Maharashtra State, India.
Iran J Otorhinolaryngol. 2016 Jan;28(84):83-8.
Invasive fungal sinusitis, though considered to be rare entity, is nowadays frequently encountered, not only in immunocompromised patients but also in immunocompetent patients. The changing prevalence towards immunocompetent hosts is due to the indiscriminate usage of broad spectrum antibiotics, steroids, and immunosuppressive drugs. Diagnosing invasive fungal sinusitis should not pose any difficulty to both the clinician [a whitish colour secretion in elderly Diabetics, and CT Scan PNS showing concretion in the sinus along with destruction of the surrounding bone] and to the pathologist; however, when the invasive fungal sinus infection presents in a form of a granuloma then its diagnosis imposes a challenge to medical professionals.
We are presenting a case study,which consists of 3 cases of chronic invasive fungal sinus infection.Two patients were treated for tuberculoma and had completed a course of Anti Koch's Treatment and one patient was given a trial of broad spectrum antibiotics and steroids.Eventually all cases were diagnosed as a chronic invasive form of fungal granuloma (CIFG).
CIFG of the paranasal sinuses is seen in immunocompetent hosts, especially those that are in the 2nd and 3rd decades of their lives. Gradually progressive proptosis is the primary presenting symptom. MRI scanning is a better imaging modality compared to CT scanning. Routine H&E staining may prove inadequate and special stains such as the GMS stain should be employed in the slightest doubt of a fungal aetiology. A team approach towards patients is paramount for early diagnosis and timely medical and surgical intervention.
侵袭性真菌性鼻窦炎虽被认为是一种罕见病症，但如今却频繁出现，不仅在免疫功能低下的患者中，在免疫功能正常的患者中也较为常见。向免疫功能正常宿主的患病率变化是由于广谱抗生素、类固醇和免疫抑制药物的滥用。对于临床医生（老年糖尿病患者出现白色分泌物，鼻窦计算机断层扫描显示鼻窦内有结石并伴有周围骨质破坏）和病理学家而言，诊断侵袭性真菌性鼻窦炎本不应有任何困难；然而，当侵袭性真菌性鼻窦感染以肉芽肿形式出现时，其诊断对医学专业人员构成了挑战。
我们呈现一个病例研究，其中包括3例慢性侵袭性真菌性鼻窦感染病例。两名患者因结核瘤接受治疗并完成了抗结核治疗疗程，一名患者接受了广谱抗生素和类固醇试验性治疗。最终所有病例均被诊断为慢性侵袭性真菌性肉芽肿（CIFG）。
鼻窦的CIFG见于免疫功能正常的宿主，尤其是二三十岁的人群。逐渐进展的眼球突出是主要的首发症状。与计算机断层扫描相比，磁共振成像扫描是更好的影像学检查方式。常规苏木精-伊红染色可能证明不足，如果对真菌病因稍有怀疑，应采用诸如吉姆萨染色等特殊染色。对于患者采用团队协作方法对于早期诊断以及及时的药物和手术干预至关重要。
