Guy Ali, Guy Angela, Rahman Masum, Kokova Marina, Abdurakhimov Azizjon, Persits Azaliia, Saliaj Kristi, Kola Ina, Cobo Anisa, Musa Juna
Department of Physical Medicine and Rehabilitation, New York University, School of Medicine, NYU Medical Center, New York, NY, USA.
Health Emphasis California School of Professional Psychology Alliant International University, Los Angeles, CA, USA.
Radiol Case Rep. 2021 Jan 26;16(4):789-794. doi: 10.1016/j.radcr.2021.01.030. eCollection 2021 Apr.
Sphenoid sinus fungal ball (FB) is a noninvasive fungal infection affecting predominantly immunocompetent middle-aged female patients. Common clinical manifestations include headaches, postnasal drip, and nasal discharge. In this case report, we present a 56-year-old female with a 10-year history of occasional dizziness, vertigo, nystagmus, feeling disoriented and feeling her eyes moving rapidly. Complaints of restlessness, insomnia, anxiety, stress and anger were also present. Due to the nonspecific nature of her symptoms, a diagnosis of sphenoid sinus FB was overlooked. Definitive diagnosis was established after performing a nasal endoscopy and subsequent histopathological examination of the collected sinus tissues. The histopathology report disclosed Aspergillosis FB with chronic sinusitis. Due to the decade long delay in diagnosis and proper treatment, septal wall collapse occurred, with the patient developing diabetes insipidus with hyponatremia that led to a massive seizure and fall, resulting in multiple disc herniations. Surgical removal of the FA elicited a complete resolution of her symptoms and a full recovery. Although fungal rhinosinusitis is a well recognized spectrum of diseases by ENT specialists, through this case report we hope to draw attention to this particular pathological entity within fungal infections, while simultaneously underlining the broad spectrum of symptoms with which it may manifest and the importance of including FA infections when considering the differential diagnosis in patients with long-standing chronic sinusitis.
蝶窦真菌球（FB）是一种主要影响免疫功能正常的中年女性患者的非侵袭性真菌感染。常见临床表现包括头痛、鼻后滴漏和鼻分泌物。在本病例报告中，我们介绍了一名56岁女性，有10年偶尔头晕、眩晕、眼球震颤、定向障碍和感觉眼睛快速移动的病史。还存在烦躁、失眠、焦虑、压力和愤怒的主诉。由于其症状的非特异性，蝶窦FB的诊断被忽视。在进行鼻内镜检查并随后对采集的鼻窦组织进行组织病理学检查后确立了明确诊断。组织病理学报告显示为曲霉菌性FB伴慢性鼻窦炎。由于诊断和适当治疗延迟了十年，鼻中隔壁塌陷，患者出现尿崩症伴低钠血症，导致大规模癫痫发作和跌倒，进而引发多处椎间盘突出。手术切除真菌球使她的症状完全缓解并完全康复。尽管真菌性鼻窦炎是耳鼻喉科专家公认的一系列疾病，但通过本病例报告，我们希望引起对真菌感染中这一特殊病理实体的关注，同时强调其可能表现出的广泛症状，以及在考虑长期慢性鼻窦炎患者的鉴别诊断时纳入真菌球感染的重要性。
