Sinusal fungal ball as a consequence of long-term hydrocortisone therapy

Ludeña-Yance R.; Yacono-Ruiz P.; Campos-Yaipen R.; Mendoza-Montoya P.; Salvador-Carrillo J. · Revista Cubana de Medicina Militar (2025)

Resumen

Introduction: Diagnosis of sinus fungal ball (SFB) remains a challenge in clinical practice. However, the use of corticosteroids in patients with autoimmune diseases may increase the risk of occurrence. Objective: To report the occurrence of sinus fungal ball after long-term treatment with hydrocortisone in an autoimmune patient. Case report: A 57-year-old patient, diagnosed with Addison's disease (AD) at age 21 and on continuous hydrocortisone therapy since then, presented to the healthcare facility. Initially, bacterial sinusitis was suspected, and he underwent multiple antibiotic courses over six months. On computed tomography, pseudopneumatization with an oval image compatible with a fungal ball was observed. Finally, SFB was removed nine months after the initial medical care. The level of causality between sinus fungal ball and hydrocortisone was "possible" and had a "moderate" severity level. Conclusions: Healthcare professionals should consider the diagnosis of sinus fungal ball in immunocompromised patients during clinical practice and should remain alert to the possibility of fungal infections as side effects of long-term corticosteroid therapy.

Instituciones: Universidad Nacional Mayor de San Marcos; Universidad Privada San Juan Bautista