A 50-year-old immunocompetent man from North India presents with slowly progressive proptosis over 8 months. Biopsy of sinus tissue shows dense fibrosis with noncaseating granulomas containing sparse fungal hyphae, with little angioinvasion. Culture grows Aspergillus flavus. Which entity is described?

• A Fungal ball of the maxillary sinus
• B Acute fulminant invasive fungal sinusitis
• C Allergic fungal rhinosinusitis
• D Granulomatous invasive fungal sinusitis ✓

Explanation

The granulomatous form of chronic invasive fungal sinusitis occurs in immunocompetent hosts, is classically caused by Aspergillus flavus, and is endemic to North Africa, the Middle East and the Indian subcontinent. Histology shows granulomatous inflammation with sparse hyphae and minimal angioinvasion, evolving over months to years. Acute invasive disease occurs in the immunocompromised with florid angioinvasion over days, while allergic fungal disease shows eosinophilic mucin rather than tissue invasion.

Reference: Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.