Abstract
A case of bilateral compound paranasal sinusitis caused by Aspergillus was encountered recently.
The case was reported here along with results of animal reactions tested by the same fungi.
The patient was 44 years old female with chief complaint of foul rhinorrhea. In the past, she had measle at age 5, and alopecia areata from 40 to 43 which was treated by infrared and ultraviolet rays and anterior pituitary hormones. Once she reportedly had maxillary sinusitis due to persistent dental carries which she suffered for two years.
General examination was negative. The nasal examination at that time revealed a small polyp in the middle meatus and profuse purulent discharge. Aspiration of the maxillary sinus yielded purely purulent material with grain sized dark brown nodules in it. A plain X-ray film taken at that time showed the right paranasal sinuses being diffusely involved. Diagnosis of bilateral compound paranasal sinusitis was made and surgery of maxillary and ethmoid sinuses were performed by endonasal approach. Pathologic changes noted at the time of the operation were papillary thickening of the mucosa, proliferation of granulation tissue and presence of the dark brown nodules either being attached to the mucosa or being suspended in the pus. The osseous walls were also thinned out or absent at places.
Histologic examinations made on the removed tissues revealed the atrophied squamous epithelia.
Aspergillary fungus balls were demonstrated being heavily stained by eosin and silver metanamine adjacent to the epithelia. Surrounding the fungus balls, noted were plasma cell infiltrations in edematous tissue indicating chronic inflammatory reactions and localized granulation formations.
Animal experiments were conducted on grown rabbits weighing over 3500 gm, using Asp. fumigatus cultured on the Sabouraud's Agar media. The rabbits were divided into two groups, Group A and B. And directly into the right maxillary sinus, liquid suspending 5×106/0.1ml fungi was instilled in Group A and small fungus balls in Group B.
After the instillations, frontal sections of the maxillary sinuses were made at certain intervals for the histologic examinations. In both groups, no systemic pathological change was brought by the instillations with the exception of the kidney which showed acute necrotic processes in some rabbits. Locally, however, acute and chronic aspergillary inflammations were recognized in Group B rabbits. The rabbits in Group A showed no significant local change.
