Case report:
A 55-year-old female was referred to our office for a three-month left
nasal obstruction concomitant with purulent nasal discharge and facial
algia non responding to many courses of oral antibiotics. Her medical
history included diabetes mellitus. The endoscopic exam revealed a
purulent rhinorrhoea and a hypertrophic middle turbinate with
granulomatous mucosa, filling the nasal cavity repressing the septum. A
computed tomography scan of paranasal sinuses showed a heterogeneous
lesion of the left Middle turbinate focally hyperdense filling the nasal
cavity and repressing the septum. Ipsilateral Maxillary, ethmoid and
frontal sinuses were entirely filled. No sinus wall erosion was noted
(figure 1). Fungal sinusitis was suspected. Our patient underwent a
functional endoscopic sinus surgery consisting in a left middle
turbinoplasty, a left middle meatotomy, a left functional endoscopic
ethmoidectomy and sphenoidotomy. However, the presence of white lumps
intraoperatively was in favour of actinomycosis (Figure 2).
Histopathology confirmed indeed the latter diagnosis given the presence
of actinomycetes (Figure 3). Thus, she received a four-week-oral
amoxicillin- clavulanic acid cure (80 mg/kg/day). The clinic and
endoscopic six-month follow-up did not reveal any sign of relapse.