[Allergic fungal rhinosinusitis]. / Rhinosinusite fongique allergique (RSF).

INTRODUCTION: Definition, diagnosis and treatment of allergic fungal sinusitis remain difficult and controversial despite the increasing number of publications. We report a case of an allergic fungal sinusitis with a review of the literature. CLINICAL CASE: A 45-year-old man consulted for sinusal polyposis resistant to steroid therapy, clinical examination objectified bilateral nasal polyps and covered with scabs. CT scan of the sinuses disclosed a sinuse filled with a tissue density material containing air with lysis of the left maxillary sinus, hypereosinophilia, the IgE levels were high. Finally, mycological investigation allowed the identification of Aspergillus fumigatus. The patient underwent total ethmoidectomy, histological study found an allergic mucin and inflammatory mucosa with numerous eosinophils. The postoperative course was good and the patient was given oral steroids. The clinical and radiological evolution was favorable without recurrence with a follow-up of three years. DISCUSSION: A set of clinical, radiological, histopathological, immunoallergological and mycological criteria is necessary for precise diagnosis and to avoid fungal drift. The treatment is based on endoscopic surgery associated with corticosteroid.

[Pseudo-tumoral Aspergillus rhinosinusitis of dental origin]. / Sinusite aspergillaire d'origine dentaire dans sa forme pseudo-tumorale.

INTRODUCTION: Sinonasal aspergillosis is caused by the interaction between the sinonasal mucosa with a cosmopolite fungus (Aspergillus), it is on the increase, this is an infection whose evolution is unpredictable requiring early diagnosis and appropriate support. We report a case of Aspergillus rhinosinusitis of dental origin in pseudo-tumoral form with a review of the literature. CLINICAL CASE: A 31 years-old, women, consulted for a right nasal obstruction with purulent rhinorrhea after dental treatment. On examination, there was a bulge of the inner canthus of the right eye and a mass in the right nasal cavity. The CT scanner showed a process of the left naso-sinus cavity centered by calcic image density. The patient underwent a total excision of the mass endoscopically. Mycological and pathological examination concluded that the etiology was Aspergillus fumigatus. The patient had not received any antifungal treatment. The postoperative course was uneventful. The evolution was favourable with no recurrence after 9 months. DISCUSSION: Aspergillus rhinosinusitis of dental origin is usually due to the emergence of canalicular filling paste into the maxillary sinus through and oral cavity and sinus fistula, neglected it can progress to invasive pseudo-tumoral form. The clinical presentation is nonspecific and the diagnosis often involves imaging (scanner). Mycological and histological examinations are essential for diagnosis. The treatment is based on surgery sometimes associated with antifungal treatment.

[Aspergillus ethmoiditis associated with orbital abscess]. / Ethmoïdite aspergillaire compliquée d'un abcès orbitaire.

The authors report a case of Aspergillus ethmoiditis associated with an orbital abscess, diagnosed in an immunocompetent 6-year-old child, this is a rare infection and diagnosis is difficult, cause of a delayed treatment and frightening prognosis. Mycoses have emerged as important infections in clinical practice; this phenomenon is explained by the ever-growing number of immunocompromised patients and the increasing number of people traveling in areas where fungal diseases are endemic. Surgery with mycological and anatomopathologic examination can suggest a fungal infection confirmed by culture and contribute to institute adequate treatment.