فهرست نشریات علمی دسترسی آزاد ایران

Granulomatous inflammation in the maxillary sinus is rare and can mimic other conditions, making diagnosis more complicated. Aspergillosis, typically a lung infection, can also affect the sinuses and large blood vessels, resulting in a multisystem disease with features similar to autoimmune disorders. Among the most important differential diagnoses and based on elevated angiotensin-converting enzyme (ACE) levels and biopsy findings, the Granulomatosis with Polyangiitis (GPA) or sarcoidosis were initially considered in this patient. A 44-year-old male farmer from Chabahar had a painless, progressively growing swelling on the right side of his face for 18 months. He reported intermittent cough and dyspnea but denied systemic symptoms. A computed tomography scan of the paranasal sinuses showed mucosal thickening, bony erosion, and a soft tissue mass in the maxillary sinus, suggesting cancer or a fungal infection. The biopsy revealed non-necrotizing granulomatous inflammation, with infectious etiologies, such as tuberculosis, excluded. Initial imaging and biopsy findings suggested malignancy or granulomatous disease, and elevated ACE levels with pulmonary imaging findings led to a diagnosis of sarcoidosis. Despite receiving corticosteroids and methotrexate, the patient exhibited no improvement after three months, highlighting a significant diagnostic delay due to an incorrect initial diagnosis. Further evaluation, including consideration of GPA and repeat biopsy, ultimately led to the identification of Aspergillus spp. on fungal culture, and treatment was adjusted to voriconazole, resulting in clinical improvement. This case highlights the importance of fungal culture and biopsy for accurate diagnosis and management, emphasizing a broad differential approach. Fungal infections should be considered in chronic granulomatous sinusitis, particularly when conventional treatment fails.