Mixed Infection With Aspergillosis and Actinomycosis in the Maxillary Sinus: A Case Report

This report describes a rare case of aspergillosis and actinomycosis occurring simultaneously in the maxillary sinus. A 74-year-old female patient visited our institution due to a chief complaint of left purulent nasal discharge. Her medical history included rheumatoid arthritis (which was treated with oral methotrexate) and diabetes mellitus. Computed tomography scan revealed soft tissue shadows and high-density areas, which are indicative of fungal balls, in the left maxillary sinus, ethmoid sinus, and frontal sinus. Magnetic resonance imaging showed a significantly low signal on the T2-weighted image that corresponded to the high-density areas observed on the computed tomography scan. Sinus fungal infection was strongly suspected, and type III endoscopic sinus surgery was performed. During the surgery, a large volume of bacterial mass-like materials with a foul odor indicating anaerobic infection was observed after the maxillary sinus was opened. Histopathological examination confirmed Aspergillus hyphae and actinomycete masses (with the Splendore-Hoeppli phenomenon). The patient was diagnosed with mixed infection with aspergillosis and actinomycosis. After the surgery, the patient was treated with penicillin drip and oral amoxicillin, and the patient exhibited a favorable clinical progress. This type of mixed infection is extremely rare. Herein, we report a rare case of mixed infection with aspergillosis and actinomycosis, and a literature review was performed.