Two Cases of Actinomycosis with Aspergillosis in Unilateral Paranasal Sinuses

Hye Kyu Min; Oh Eun Kwon; Jin Young Min; Sung Wan Kim

doi:10.18787/jr.2019.26.2.122

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Min, Kwon, Min, and Kim: Two Cases of Actinomycosis with Aspergillosis in Unilateral Paranasal Sinuses

Case Report

J Rhinol 2019;26(2):122-126.

Published online: 20 January 2019

DOI: https://doi.org/10.18787/jr.2019.26.2.122

Two Cases of Actinomycosis with Aspergillosis in Unilateral Paranasal Sinuses

Hye Kyu Min, MD¹, Oh Eun Kwon, MD^1,², Jin Young Min, MD, PhD¹, Sung Wan Kim, MD, PhD¹

¹Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea

²Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Korea

교신저자： 김성완, 02447 서울시 동대문구 경희대로 23 경희대학교 의과대학 이비인후과학교실 Tel: +82-2-958-8474, Fax: +82-2-958-8470, E-mail: drkimsw@hanmail.net

Received 24 June 2019 Revised 19 November 2019 Accepted 23 November 2019

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

Actinomycosis of paranasal sinus is a very rare disease that is caused by infection of Actinomyces species that were present in oral or nasal flora due to trauma or dental treatment. Actinomycosis shows a local calcified lesion associated with soft tissue density on computed tomography, which is similar to fungal sinusitis. Actinomycosis associated with fungal ball due to Asper-gillus affecting sinus ventilation has been rarely reported. We experienced two cases of actinomycosis associated with fungal ball and successfully treated with endoscopic sinus surgery and oral antibiotics for 3 months without recurrence.

Keywords: Actinomycosis, Aspergillosis, Fungal ball, Paranasal sinus

References

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Fig. 1.

Preoperative findings of case 1. Endoscopic finding shows purulent discharge (A) and fungal ball (B) from middle meatus. Pa-ranasal sinus coronal CT scan image shows soft tissue density and calcified lesion (white arrow) of right maxillary sinus (C).

Fig. 2.

Pathologic findings of case 1. The fungal ball from right maxillary sinus shows branching septate hyphae of Aspergillus (white ar-rows)(H&E stain, ×200)(A). There is a sulfur granule composed of radiating filaments and surrounded by inflammatory cells (white ar-rows)(H&E stain, ×200)(B).

Fig. 3.

Preoperative finding of case 2. Paranasal sinus coronal CT scan images of case 2. It shows focal calcified lesion (white arrow) and soft tissue density of right anterior ethmoid sinus (A) and maxillary sinus (B).

Fig. 4.

Pathologic findings of case 2. The fungal ball from right maxillary sinus and ethmoid sinus shows branching septate hyphae of Aspergillus (white arrows)(H&E stain, ×200)(A). There is a sulfur granule composed of radiating filaments (white arrows)(H&E stain, ×200) (B).

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