A 50-year-old immunocompetent farmer from rural India presents with 6 months of progressive left nasal blockage, purulent rhinorrhoea, and dull facial pain. Endoscopy shows a polypoid mass with crusting in the middle meatus; biopsy reveals fungal hyphae invading the mucosa with surrounding granulomatous inflammation. Which organism is the most likely cause of this chronic invasive fungal sinusitis?
- A Candida albicans
- B Rhizopus arrhizus
- C Aspergillus flavus ✓
- D Fusarium species
Correct answer: C. Aspergillus flavus
Explanation
Chronic invasive fungal sinusitis occurs typically in apparently immunocompetent patients, runs an indolent course over months, and shows tissue invasion with dense granulomatous inflammation on histology. In India and other tropical regions, Aspergillus flavus is by far the most frequently isolated organism. Mucorales such as Rhizopus cause the acute fulminant disease of uncontrolled diabetics, not this slow granulomatous form, while Candida and Fusarium are rare causes seen mainly in profound neutropenia.
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.