Aspergillosis is the most common fungal infection of the paranasal sinuses, which needs to be recognized as it requires surgical treatment. Paranasal fungal sinusites are classified into two categories: invasive and non-invasive pathologies. Invasive forms include acute fulminant fungal sinusitis and chronic invasive mycosis. Non-invasive forms include allergic fungal sinusitis and fungus ball. Aspergillus fumigatus is the most common species recovered from cases of invasive aspergillosis. The next most commonly recovered species are A. fl avus, A. niger and A. terreus.
Diagnosis for proven aspergillosis requires histopathological documentation of infection and a positive result of the culture of a specimen from a normally sterile site. Functional endoscopic sinus surgery is the golden standard for treatment of noninvasive aspergillosis and there is no need for antifungal therapy. Invasive aspergillosis requires more agressive surgery and antifungal therapy to prevent dissemination and relapses of the disease.
An illustrative overview of the case of a 54-year-old man with chronic sinusitis and aspergillosis is given.