Matsumoto Naoyuki, Kagoya Ryoji, Yasui Mariko, Uozaki Hiroshi, Ito Ken
Otolaryngology, Teikyo University, Tokyo, JPN.
Otorhinolaryngology-Head and Neck Surgery, The University of Tokyo, Tokyo, JPN.
Cureus. 2023 May 26;15(5):e39548. doi: 10.7759/cureus.39548. eCollection 2023 May.
Fungal rhinosinusitis (FRS) presents as various phenotypes ranging from asymptomatic colonization to life-threatening infections. Here, we report an atypical case of FRS of the left maxillary sinus that extended to the contralateral maxillary sinus through the nasal septum. An 80-year-old woman with a history of osteoporosis was referred to our hospital for further management of headaches and chronic rhinosinusitis. Computed tomography (CT) of the sinus revealed a mass lesion with calcification in the left maxillary sinus, extending to the contralateral maxillary sinus through the nasal septum. T1-weighted and T2-weighted magnetic resonance imaging revealed a mass lesion with low-intensity signals. Endoscopic sinus surgery was performed for the diagnosis and treatment. Histopathological examination revealed fungal elements in the caseous material of the left maxillary sinus. However, no tissue-invasive fungal forms were found. Additionally, eosinophilic mucin was not observed. Based on these findings, the patient was diagnosed with fungus ball (FB). To the best of our knowledge, there are no reports of a FB extending contralaterally through the nasal septum. This report serves as a reminder that FB can extend into contralateral paranasal sinuses through the nasal septum and the possibility that osteoporosis is a cause of extensive bone destruction.
真菌性鼻窦炎（FRS）表现为从无症状定植到危及生命的感染等多种表型。在此，我们报告一例非典型的左上颌窦真菌性鼻窦炎病例，该病例通过鼻中隔扩展至对侧上颌窦。一名有骨质疏松病史的80岁女性因头痛和慢性鼻窦炎被转诊至我院进一步治疗。鼻窦计算机断层扫描（CT）显示左上颌窦有一个伴有钙化的肿块病变，通过鼻中隔延伸至对侧上颌窦。T1加权和T2加权磁共振成像显示有一个低强度信号的肿块病变。为明确诊断和治疗进行了鼻内镜鼻窦手术。组织病理学检查在左上颌窦的干酪样物质中发现了真菌成分。然而，未发现组织侵袭性真菌形态。此外，未观察到嗜酸性黏液。基于这些发现，该患者被诊断为真菌球（FB）。据我们所知，尚无FB通过鼻中隔向对侧扩展的报道。本报告提醒人们，FB可通过鼻中隔扩展至对侧鼻窦，以及骨质疏松可能是广泛骨质破坏原因的可能性。
