The bedroom door slammed shut! I sighed and walked away. It was yet another argument with my teenage daughter. Don’t get me wrong. She is a wonderful girl and an excellent student. However, she longed for a dog and we had been “discussing” this issue for over a year. I just could not accept the responsibility of caring for another individual, not to mention cleaning up its “mess” in and outside the house. Again, I put it off the “project” for a few more months.
Then one day I met “Bella”. She came to see me for chronic infections manifested by fungus balls in her sinus cavities. She underwent surgery to clean out the infected sinus cavities and was followed in the office on a regular basis as she improved. During her visits, she would often chat about her dogs and the exceptional bond they shared. I could see the love and pride in her eyes as she talked about them. Sometimes she would even bring me their beautiful pictures. It was because of her that I got much more comfortable with the idea of having a pet, and finally agreed to a puppy much to my daughter’s immense delight!
Teddy came to our house when he was only six weeks old.
Oh my, things have certainly changed! He only sleeps on a pile of cushions placed on a bed, and leaves his toys all over the house. We sometimes have to carry him, or place him in an old stroller when it is time for his “walk”. Snacks include fresh cooked turkey slices from the store. Although spoiled by the entire family, he continues to give us all immense joy and love, just as Bella described.
More about Fungal Sinusitis
Fungal Sinusitis can be divided into several categories.
Fungus balls or Mycetoma can cause sinus pressure and bad breath. CT scan findings are fairly characteristic with hyperdensity. These “balls” are not invasive but need to be surgically removed. Intraoperatively, one finds thick clumps of ‘clay like’ or ‘cheesy’ material with a dark greenish black color. They can recur and affected patients therefore need to be monitored carefully for a prolonged period of time.
Allergic fungal sinusitis is a more diffuse form related to hypersensitivity to specific fungi in allergic individuals. They are often found with nasal polyps. CT scan will show opacified sinuses, hyperattenuation, and sometimes flecks of calcification. Intraoperatively, one finds thick ‘peanut butter’ like tenacious greenish black or brown debri. Medical and surgical treatments are required, along with consideration towards immunotherapy to prevent further recurrences.
Invasive fungal sinusitis is an aggressive destructive disease with vascular invasion. They can be caused by Mucormycosis or Aspergillosis. These infections occur in immunocompromised and diabetic patients. CT scan shows progressive soft tissue and bony destruction within the sinus cavities. Intracranial and orbital extension can also occur and patients require early aggressive treatment with Surgery and IV antifungal medications in view of the high mortality rate.
