Non-invasive Fungal Rhinosinusitis

A generally fit and well 63-year-old lady presented to her GP complaining about retro-orbital headache and mucopurulent discharge. She was initially treated as having a common cold. Later on, the patient developed double vision and ptosis on the left eye. She was subsequently referred to our department for further investigations and definite treatment. On clinical examination, she complained about persistent nasal congestion and mucopurulent discharge. Headache and opthalmological symptoms deteriorated over the time. Flexible nasendoscopy revealed mucopurulent discharge coming from the sphenoethmoidal recess. Ophthalmology review confirmed left oculomotor nerve palsy while CT scan showed complete opacification of the left sphenoid sinus and thickening of the sinus walls (Fig. 14.1). She was started empirically on intravenous broad spectrum antibiotics with no significant clinical improvement. The patient underwent endoscopic sinus surgery, during which the surgeon identified debris coming out of the widened sphenoid ostium (Fig. 14.2). Histological evaluation of the specimen showed nonseptate fungal colonies accompanied by cellular debri and numerous neutrophils. The patient was under regular follow up for 6 months, and no recurrence was noted. Endoscopic evaluation of the nose was unremarkable and the ocular symptoms eventually improved.