J Rhinol.  2019 Nov;26(2):122-126. 10.18787/jr.2019.26.2.122.

Two Cases of Actinomycosis with Aspergillosis in Unilateral Paranasal Sinuses

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea. drkimsw@hanmail.net
  • 2Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Korea.


Actinomycosis of paranasal sinus is a very rare disease that is caused by infection of Actinomyces species that were present in oral or nasal flora due to trauma or dental treatment. Actinomycosis shows a local calcified lesion associated with soft tissue density on computed tomography, which is similar to fungal sinusitis. Actinomycosis associated with fungal ball due to Aspergillus affecting sinus ventilation has been rarely reported. We experienced two cases of actinomycosis associated with fungal ball and successfully treated with endoscopic sinus surgery and oral antibiotics for 3 months without recurrence.


Actinomycosis; Aspergillosis; Fungal ball; Paranasal sinus

MeSH Terms

Anti-Bacterial Agents
Paranasal Sinuses*
Rare Diseases
Anti-Bacterial Agents


  • Fig. 1. Preoperative findings of case 1. Endoscopic finding shows purulent discharge (A) and fungal ball (B) from middle meatus. Pa-ranasal sinus coronal CT scan image shows soft tissue density and calcified lesion (white arrow) of right maxillary sinus (C).

  • Fig. 2. Pathologic findings of case 1. The fungal ball from right maxillary sinus shows branching septate hyphae of Aspergillus (white ar-rows)(H&E stain, ×200)(A). There is a sulfur granule composed of radiating filaments and surrounded by inflammatory cells (white ar-rows)(H&E stain, ×200)(B).

  • Fig. 3. Preoperative finding of case 2. Paranasal sinus coronal CT scan images of case 2. It shows focal calcified lesion (white arrow) and soft tissue density of right anterior ethmoid sinus (A) and maxillary sinus (B).

  • Fig. 4. Pathologic findings of case 2. The fungal ball from right maxillary sinus and ethmoid sinus shows branching septate hyphae of Aspergillus (white arrows)(H&E stain, ×200)(A). There is a sulfur granule composed of radiating filaments (white arrows)(H&E stain, ×200) (B).



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