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Frontal sinus destruction from allergic eosinophilic fungal rhinosinusitis
Walter A Schroeder1, David G Yingling, Paul C Horn
1Dept. of Surgery, St. Francis Medical Center, Cape Girardeau.
Abstract:
Extensive fungal infections of the paranasal sinuses are most often associated with immunocompromised patients or poorly controlled diabetics. Seldom do young, otherwise healthy patients present with advanced disease destroying bone and compressing the dura and frontal lobe posteriorly. A case of eosinophilic fungal rhinosinusitis which grew Curvularia lunata in culture is reported. Bone destruction can be common as an expanding inflammatory mass pushes and weakens surrounding bone. The destruction of the frontal sinus with the compression of the dura into the anterior cranial fossa of a 26-year-old requires drainage, reconstruction, and medical management. Our experience with the disease and our approach is reviewed.
Insights
A rare case of eosinophilic fungal rhinosinusitis caused by Curvularia lunata in a healthy young adult is presented. This aggressive infection destroyed bone and compressed the brain, requiring surgical intervention and medical management.
Area of Science:
- Mycology
- Neurosurgery
- Otolaryngology
Background:
- Extensive fungal rhinosinusitis typically affects immunocompromised individuals or those with uncontrolled diabetes.
- Advanced fungal sinusitis rarely presents in young, healthy patients with significant bone destruction and intracranial complications.
Observation:
- A case of eosinophilic fungal rhinosinusitis is detailed, with Curvularia lunata identified in cultures.
- A 26-year-old patient presented with frontal sinus destruction and compression of the dura and frontal lobe.
Findings:
- Bone destruction is a common feature, resulting from the pressure of an expanding inflammatory fungal mass.
- The case highlights the potential for aggressive fungal sinusitis to cause severe damage in seemingly healthy individuals.
Implications:
- Prompt diagnosis and management, including surgical drainage and reconstruction, are crucial for favorable outcomes.
- This case underscores the importance of considering aggressive fungal sinusitis in young, healthy patients with unexplained sinonasal and neurological symptoms.