Acute Fungal Rhinosinusitis

Abstract

A 39-year-old male patient with a medical history of autologous bone marrow transplantation 2 months ago due to relapse of a B-cell Hodgkin’s Lymphoma, was admitted to Haematology Department with symptoms of worsening nasal congestion, purulent nasal discharge, persistent high fever, midfacial pain, and hard palate numbness. An urgent ENT assessment was requested. Nasal endoscopy revealed oedematous nasal mucosa, purulent nasal discharge, and black crust formation inside the right nostril. Multiple swabs, along with tissue samples, were collected for microbiological cultures and histopathological examination. Intraoral examination revealed a black ulcer with irregular margins over the right side of the hard palate, approximately 2 × 2 cm² in dimensions. Cranial nerve function was unremarkable. An urgent contrast-enhanced CT scan of the head and paranasal sinuses was performed, showing right maxillary sinus opacification with bone erosion (Fig. 5.1). Laboratory studies revealed elevated ESR and neutropenia. Blood cultures were also obtained. An urgent sinus MRI (Figs. 5.2 and 5.3) was performed, and the patient was taken to theatre for surgical debriment of the necrotic tissue, middle meatal antrostomies and biopsies under general anesthesia. A high dose of Amphotericin B was administered intravenously. The suspected diagnosis of mucormycosis, a subtype of Acute Invasive Fungal Sinusitis was confirmed.