The Journal of Laryngology & Otology

Clinical Records

Unusual coexistence of sinonasal myeloid sarcoma and acute fulminant invasive fungal sinusitis: a diagnostic dilemma

C-L Kuoa1a4, Y-B Yua2, W-Y Lia3 and Y-L Leea1 c1

a1 Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan

a2 Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan

a3 Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan

a4 Department of Otorhinolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan

Abstract

Objective: We report a rare case of concurrent myeloid sarcoma and acute fulminant invasive fungal sinusitis in a patient with relapsed acute myeloid leukaemia.

Case report: A 73-year-old man was diagnosed with acute myeloid leukaemia and developed relapse one year later. After two courses of azacytidine, he began suffering from a dull pain in the left temporal and orbital regions. Sinus computed tomography showed a localised lesion in the left ethmoid sinus, which rapidly progressed to an extensive intracranial mass within one month. Surgical debridement was performed, and histopathological analysis revealed the coexistence of myeloid sarcoma and acute fulminant invasive fungal sinusitis. The patient responded well to prompt surgical debridement, antifungal medication and radiotherapy.

Conclusion: Coexistence of sinonasal myeloid sarcoma and acute fulminant invasive fungal sinusitis poses an urgent diagnostic and management challenge to clinicians. Timely recognition of this rare comorbid condition is warranted as application of appropriate treatment can save lives.

(Accepted June 28 2012)

(Online publication February 28 2013)

Key words

  • Fungi;
  • Paranasal Sinuses;
  • Sinusitis;
  • Chloroma;
  • Sarcoma, Myeloid;
  • Leukemia

Correspondence

c1 Address for correspondence: Dr Yi-Lun Lee, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital and National Yang-Ming University, No 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan Fax: +886 2 2875 5715 E-mails: drtgud@gmail.com; allenlee0730@gmail.com

Footnotes

  Dr Yi-Lun Lee takes responsibility for the integrity of the content of the paper

Competing interests: None declared

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