A middle-aged farmer from north India presents with slowly progressive unilateral nasal obstruction and proptosis over several months. Biopsy of the sinus mucosa shows dense granulomas containing sparse fungal hyphae, with fibrosis but minimal necrosis. Which organism is classically responsible for this form of invasive fungal sinusitis?

• A Mucor species
• B Candida albicans
• C Rhinosporidium seeberi
• D Aspergillus flavus ✓

Explanation

Granulomatous invasive fungal sinusitis is a chronic, indolent form caused by Aspergillus flavus, classically described in Sudan, the Middle East and northern India. Histology shows granulomatous inflammation with giant cells, fibrosis and sparse hyphae, unlike the angioinvasion and extensive necrosis of acute mucormycosis. Rhinosporidium causes vascular polypoidal lesions rather than granulomatous sinusitis, and Candida is not a recognized cause of this entity.

Reference: Cummings Otolaryngology Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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