Chronic sinonasal aspergillosis with associated mucormycosis.

A 40-year-old man, a physician, presented to us with a history of nasal obstruction, proptosis, and diplopia on medial gaze. The nasal obstruction had been present for 2 years and the proptosis and diplopia for 2 months. He also had a history of nasal allergy and headache.

Believing that he had sinusitis, the patient had been self-medicating for 2 years with various antibiotics (e.g., gatifloxacin, amoxicillin, cloxacillin, and amoxicillin/clavulanic acid) and nasal decongestants (e.g., oxymetazoline). He finally sought an ENT consultation after becoming alarmed by the development of the diplopia.

Nasal examination revealed nasal polyposis bilaterally. Noncontrast computed tomography (CT) of the paranasal sinuses demonstrated extensive disease in the fight maxillary sinus, fight ethmoid sinus, and fight sphenoid sinus along with destruction of the lamina papyracea, displace ment of the globe, and erosion of the cribriform plate (figure). The disease on the left side was limited to the ethmoid and sphenoid sinuses. CT also showed areas of calcification suggestive of underlying fungal pathology.

The patient was taken for functional endoscopic sinus surgery under general anesthesia. Extensive fungal muck along with diffuse polyposis was encountered on both sides. The dura was intact. All disease was successfully cleared and sent for examination. The muck was identified as aspergillosis with mucormycosis. The patient was started on oral itraconazole and intravenous amphotericin B, and he remained disease-free on regular endoscopic follow-up.

Ramandeep S. Virk, MS; Pankaj Arora, MS

From the Department of Otolaryngology-Head and Neck Surgery, Virk Indus ENT and Endoscopy Institute, Mohali, Punjab, India. Dr. Virk is currently at Post Graduate Institute of Medical Education and Research, Chandignrb, India. This case was seen when Dr. Virk was in private practice.