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Clinical Challenge
June 2015

Progressive Unilateral Nasal Congestion, Facial Pain, and Vision Change in an Immunocompetent Patient

Author Affiliations
  • 1The University of Chicago Medicine and Biological Sciences, Chicago, Illinois
JAMA Otolaryngol Head Neck Surg. 2015;141(6):579-580. doi:10.1001/jamaoto.2015.0352

A man in his 60s had an 8-month history of right-sided nasal congestion and rhinorrhea. He had no clinically significant improvement in symptoms despite multiple courses of oral antibiotics. Over the previous 2 months, he had developed progressive right-sided facial swelling, pain, blurred vision, and a 6.8-kg weight loss. There was no history of immunocompromise or foreign travel. A computed tomographic (CT) scan at an outside hospital showed complete opacification and an invasive process centered in the right maxillary sinus. An endoscopic maxillary antrostomy and biopsy showed inflammatory changes and numerous fungal organisms consistent with Aspergillus species. The patient was started on treatment with intravenous antifungal and broad-spectrum antibiotics, and he was transferred for further evaluation and management. The patient’s examination was notable for right-sided facial and periorbital swelling, severe pain, and limitation of lateral gaze of the right eye. A repeated CT scan was completed (Figure).