A case of chronic invasive fungal sinusitis with invasion of the nasolacrimal duct

Chronic invasive fungal sinusitis is recognized as one type of fungal sinusitis, however, there are few case reports of this disease and patients with this disease are rare. We report herein on a 60-years-old male patient with chronic invasive fungal sinusitis treated by surgery and an antifungal drug. The patient had been suffering from lacrimation and slight pain of the right eye for three years. Right maxillary sinusitis was detected on brain magnetic resonance imaging (MRI) and he was referred to our hospital. Computed tomography (CT) detected opacity of the right maxillary area with calcification. Both Tl-weighted and T2-weighted MRI showed a low signal lesion of the right maxillary sinus with invasion of the right nasolacrimal duct. Blood chemistry revealed that β-D glucan levels were high (42.1 pg/ml). Because the time course of the disease had been very long and the nasolacrimal duct was invaded, chronic invasive fungal sinusitis in the right maxillary sinus was the final diagnosis. A lateral rhinotomy was performed with reconstruction of right nasolacrimal duct and voriconazole was administered for 8 days after the operation. The pathological sample revealed major fungal invasion of the sinus mucosa shown to be Aspergillus with immunostaining. The patient has now been without recurrence for 21 months. A standard treatment of chronic invasive fungal sinusitis has not been established and has varied in the few case reports available; one of them reported treatment with only an operation and the other reported treatment with an operation and an antifungal drug. Our results showed that the combination of an operation and an antifungal drug was effective in the treatment of chronic invasive fungal sinusitis.