An otherwise healthy man from Sudan presents with progressive painless swelling over the maxilla and nasal obstruction over two years. Biopsy of sinonasal tissue shows noncaseating granulomas with vasculitis and sparse fungal hyphae, with no necrotic eschar. Culture grows Aspergillus flavus. Which entity best fits these findings?

• A Granulomatous invasive fungal sinusitis ✓
• B Allergic fungal rhinosinusitis
• C Acute fulminant invasive fungal sinusitis
• D Wegener granulomatosis (granulomatosis with polyangiitis)

Explanation

Granulomatous invasive fungal sinusitis is the indolent, chronic invasive form seen in immunocompetent patients in North Africa and Sudan, classically caused by Aspergillus flavus, producing granulomas with giant cells and vasculitis and behaving like a slowly destructive tumor. GPA also gives granulomatous inflammation but lacks identifiable fungal hyphae on culture, and allergic fungal disease contains eosinophilic mucin rather than tissue-invasive granulomas.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.