Chronic granulomatous invasive fungal maxillary sinusitis: Report of the first case from South Africa

A 37-year-old South African woman was referred to an ear, nose and throat (ENT) specialist with a history of painful maxillary sinusitis with nasal obstruction. Five days prior to her presentation, she was admitted to a hospital emergency unit with clinical symptoms of headache, nausea, rigor, red eyes, body pain (back and chest pain) and photophobia. She was subsequently diagnosed with a viral infection, and was investigated to exclude the possibility of meningitis. Her blood test results revealed a shifting raised neutrophil count (9.6) and creatinine (79) but a CRP of less than 5, and further test results were normal. A computed tomography (CT) scan showed no evidence of focal brain lesions, cerebral oedema or hydrocephalus. However, there were radiological features of an enlarged left maxillary sinus ostium, which the radiologist reported as suggestive of previous sino-nasal surgery. There was also mucosal thickening of the maxillary sinuses. The mucosal lining was significantly thicker on the left side, where high density material was present.