Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 451-463
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.451
Analysis of pathogenetic process of fungal rhinosinusitis: Report of two cases
Lin-Lin Wang, Feng-Ji Chen, Long-Su Yang, Jie-En Li
Lin-Lin Wang, Feng-Ji Chen, Long-Su Yang, Jie-En Li, Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning 530022, Guangxi Zhuang Autonomous Region, China
Author contributions: Wang LL did the literature review and wrote the case report; Chen FJ and Yang LS attended the patients and edited this manuscript; all authors have read the manuscript and accepted the final version.
Informed consent statement: Written informed consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jie-En Li, MD, Professor, Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning 530022, Guangxi Zhuang Autonomous Region, China. lijieen@stu.gxmu.edu.cn
Received: October 30, 2019
Peer-review started: October 30, 2019
First decision: December 4, 2019
Revised: December 21, 2019
Accepted: January 2, 2020
Article in press: January 2, 2020
Published online: January 26, 2020
Abstract
BACKGROUND

Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear. Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported.

CASE SUMMURY

We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis.

CONCLUSION

According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status, and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.

Keywords: Fungal rhinosinusitis, Aspergillosis, Fungus ball, Sinus surgery, Classification, Diagnosis, Case report

Core tip: Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. But the physiological mechanism is not yet clear. In this paper, we report two such cases in an unprecedented way and describe the complete pathologic progression from harmless fungal colonization to fungal sinusitis. We speculate that the onset process of fungal rhinosinusitis from scratch takes about one to three years, and the length of the process may be related to the basic diseases, surgical treatment, low autoimmune status, and abuse of hormone antibiotics and hormones. These findings may have implications for the treatment and prevention of fungal rhinosinusitis.