Treviño-Gonzalez Jose Luis, Santos-Santillana Karla Marisol, Maldonado-Chapa Felix, Morales-Del Angel Josefina Alejandra, Gomez-Castillo Paola, Cortes-Ponce Jose Rosmal
Otolaryngology and Head and Neck Surgery Division, School of Medicine and University Hospital "Dr. Jose E. González", Universidad Autónoma de Nuevo León, Dr. José Eleuterio González (Gonzalitos) S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico.
Ann Med Surg (Lond). 2021 Dec;72:103129. doi: 10.1016/j.amsu.2021.103129. Epub 2021 Dec 2.
Granulomatous chronic invasive fungal rhinosinusitis (GCIFR) is a rare entity with scarce cases reported mainly in subtropical areas. Its prevalence among individuals with clinical suspicion of fungal rhinosinusitis has been reported in approximately 20% in subtropical populations, unlike North America with a prevalence of 0.5%. It is typically associated with Aspergillus flavus and the presence of noncaseating granulomas or Langerhans giant cells on histopathologic examination.
We describe a case of a patient with clinical history of recent SARS-CoV-2 infection and development of intense cephalalgia, visual impairment, palpebral ptosis, and limitation of extraocular movements. MRI demonstrated the presence of opacification of paranasal sinuses, and a left intraconal abscess. A surgical endoscopic approach was performed and histopathologic examination revealed frontal GCIFR and maxillary fungus ball. Treatment with IV azoles provided adequate clinical response.
The spectrum of the fungal rhinosinusitis disease is not clear. However, non-invasive fungal rhinosinusitis is not often found concomitantly with invasive types. GCIFR typically manifests with an indolent and gradual progression at early stages. Advanced stages can exhibit orbital and intracranial involvement leading to visual impairment, frequent relapses, and a poor prognosis. A higher incidence of invasive fungal rhinosinusitis has been reported in patients with SARS-CoV-2 infection despite an unremarkable medical history, associated with immune dysregulation.
GCIFR is a rare condition with few cases reported in America. Because of its uncommonness, its diagnosis is often delayed leading to increased morbidity and mortality.
肉芽肿性慢性侵袭性真菌性鼻窦炎（GCIFR）是一种罕见疾病，主要在亚热带地区有少量病例报道。据报道，在临床怀疑为真菌性鼻窦炎的人群中，其在亚热带人群中的患病率约为20%，而在北美患病率为0.5%。它通常与黄曲霉有关，组织病理学检查可见非干酪样肉芽肿或朗汉斯巨细胞。
我们描述了一例患者，有近期感染SARS-CoV-2的病史，并出现剧烈头痛、视力障碍、上睑下垂和眼球运动受限。磁共振成像（MRI）显示鼻窦混浊，左侧肌锥内脓肿。采用手术内镜方法，组织病理学检查显示为额部GCIFR和上颌真菌球。静脉注射唑类药物治疗取得了良好的临床效果。
真菌性鼻窦炎疾病谱尚不清楚。然而，非侵袭性真菌性鼻窦炎通常不与侵袭性类型同时出现。GCIFR早期通常表现为隐匿性和渐进性发展。晚期可出现眼眶和颅内受累，导致视力障碍、频繁复发和预后不良。尽管病史无异常，但据报道SARS-CoV-2感染患者侵袭性真菌性鼻窦炎的发病率较高，这与免疫失调有关。
GCIFR是一种罕见疾病，在美国报道的病例较少。由于其罕见性，其诊断往往延迟，导致发病率和死亡率增加。
