A 55-year-old woman presents with unilateral facial pain and nasal obstruction. CT shows a hyperdense mass with calcifications within an opacified maxillary sinus. Endoscopic examination reveals a gritty, clay-like material. What is the most likely causative organism and appropriate treatment?
- A Candida species; oral fluconazole
- B Mucor species; intravenous amphotericin B and debridement
- C Aspergillus species; endoscopic sinus surgery with removal of fungal debris ✓
- D Bacterial biofilm; prolonged antibiotic therapy
Correct answer: C. Aspergillus species; endoscopic sinus surgery with removal of fungal debris
Explanation
Fungal ball (mycetoma) of the sinus is a non-invasive form of fungal sinusitis most commonly caused by Aspergillus species. It presents with unilateral sinus opacification, hyperdense material with calcifications on CT, and intraoperative gritty debris. Unlike invasive fungal sinusitis, there is no tissue invasion. Treatment is endoscopic removal of the fungal ball with restoration of sinus drainage; antifungal therapy is not required. Mucor causes acute invasive disease in immunocompromised patients.
Reference: Cummings Otolaryngology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.