A Case of Fungal Ball Causing Acute Dacryocystitis

You sook Hwang; Hee Jung Yang; Ji Sun Paik; Suk-Woo Yang

doi:10.3341/jkos.2017.58.4.455

Journal List > J Korean Ophthalmol Soc > v.58(4) > 1010747

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Hwang, Yang, Paik, and Yang: A Case of Fungal Ball Causing Acute Dacryocystitis

Original Article

J Korean Ophthalmol Soc 2017;58(4):455-458.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.4.455

A Case of Fungal Ball Causing Acute Dacryocystitis

You sook Hwang, M.D., Hee Jung Yang, M.D., Ji Sun Paik, MD, PhD, Suk-Woo Yang, MD, PhD

Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Suk-Woo Yang, MD, PhD Department of Ophthalmology, The Catholic University of Korea Seoul St. Mary’s Hospital, #222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: 82-2-3779-1848, Fax: 82-2-761-6869 E-mail: yswoph@hanmail.net

Received 17 November 20161 February 2017 Accepted 22 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report a case of fungal ball after Endoscopic Dacryocystorhinostomy (DCR) in a 40-year-old female patient.

Case summary

A 40-year-old female patient was admitted to our hospital for left lower eyelid tenderness and bloody discharge from the lacrimal punctum. During a planned endoscopic DCR, the sac was opened after the osteotomy, and 2 fungal balls were found in the lacrimal sac. The masses were 7 × 5 mm and, 9 × 5 mm sized, irregularly shaped, and red in color. Aspergillus fumi-gatus was diagnosed pathologically. Postoperative paranasal sinus magnetic resonance imaging showed no residual fungal ball. During follow-up, the patient showed patent rhinostomy opening, and there was no evidence of fungal infection on nasal en-doscopic finding.

Conclusions

Although Aspergillus fumigatus is a rare cause of canalicular obstruction, fungal ball development in the lacrimal sac can cause acute dacryocystitis.

Keywords: Acute dacryocystitis, Aspergillus fumigatus, Dacryocystorhinostomy (DCR), Fungal ball

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Figure 1.

Gross finding of mass. 7 × 5 mm, 9 × 5 mm sized, ir-regularly shaped, red colored 2 fungal balls obstructing the lac-rimal sac.

Figure 2.

Histologic finding of fungal ball (Periodic acid– Schiff stain, ×200). Numerous septated branched fungal hy-phae with degeneration and inflammatory cells, consistent with Aspergillosis.

Figure 3.

Paransal sinus magnetic resonance imaging (MRI), showing left ethmoid sinusitis. There is no remained visible fungal ball. (A) Coronal T2 MR image. (B) Axial T2 MR image.

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