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KMID : 0361020230660040234
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Korean Journal of Otolaryngology - Head and Neck Surgery
2023 Volume.66 No. 4 p.234 ~ p.240
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Life-Threatening Sinonasal Invasive Aspergillosis Easily Misdiagnosed
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You Yeon-Seok
Koh Ji-Hoon
Kim Byeong-Jin
Lee Eun-Jung
Kwon Sam-Hyun
Kwon Sam-Hyun
Kim Jong-Seung
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Abstract
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Background and Objectives Invasive fungal sinusitis is extremely rare. Yet the conse-quences of this infection may be fatal if not diagnosed correctly at an early stage. We discussthree cases of Aspergillosis sphenoid sinusitis that were misdiagnosed and have led to fatalconsequences.
Subjects and Method This is a retrospective analysis of cases diagnosed as invasive fungalsinusitis of sphenoid sinus.
Results All three cases were of men who had immunocompromised medical histories thatincluded leukemia and diabetes mellitus. The patients presented symptoms that included fe-ver, chronic headache, weakness on one side, and facial edema. In the first case, CT showedno suspicious lesions that indicated fungal infection. However, five days after being prescribedantibiotics, the patient suffered obstruction of the right internal carotid artery (ICA) and rightcavernous sinus. In the second case, CT showed total obstruction in the left ICA and a soft tis-sue mass in the left sphenoid sinus that extended and involved the left cavernous sinus. In thelast case, CT showed soft density progression in the right sphenoid sinus with bone erosionwhen compared to images taken eight days earlier. In each of these cases, we performed emer-gency endoscopic sinus surgery. One case was confirmed to be invasive aspergillosis by his-tology whereas the other two cases were suspected to be invasive aspergillosis based on theirpast medical histories, clinical findings and image studies.
Conclusion Clinicians must take great care to rule out invasive aspergillosis in immuno-compromised patients with sinusitis.
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KEYWORD
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Fungi, Mycoses, Sphenoid sinus
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