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Foreign body insertion inside the nose is not uncommon in pediatric age groups. It can pass unnoticed by parents, sometimes underdiagnosed or incompletely removed by a clinician. In another scenario, it may be incidentally discovered by imaging during dental workups commonly. This foreign body acts like a nidus for a rhinolith, as it gets calcified over years and becomes like a stone, causing unilateral nasal symptoms. Herein, we present a case of a young female with a rhinolith mistaken for fungal mud. We aim to emphasize this rare clinical condition that, if left unperceived, may lead to complications including, but not limited to, sinusitis, pressure necrosis to the surrounding structure causing septal perforation, or naso-palatal fistula., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alrayes et al.)

Allergic fungal rhinosinusitis is an immunoglobulin E-mediated disease caused by fungal antigens. Orbital complications due to bone erosion by the expanding, mucin-filled sinuses are considered uncommon, but they require immediate intervention. We report a successful management of a complicated case of allergic fungal rhinosinusitis in a 16-year-old female complaining of progressive nasal obstruction for four months, who only sought medical advice after developing proptosis and visual affection. The patient underwent surgical debridement and corticosteroid therapy followed by dramatic improvement of proptosis and vision. The differential diagnosis of proptosis with sinusitis must include allergic fungal rhinosinusitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alharbi et al.)

Aspergillosis is a disease that can manifest itself in both invasive and non-invasive forms. Noninvasive aspergillosis usually affects a healthy host, manifesting as a fungal hyphae cluster or an allergy. In a healthy host, localized invasive infection of damaged tissue is prevalent, but in immunocompromised patients, more extensive infection is often evident, which carries a high mortality rate. Invasive aspergillosis of the paranasal sinuses is a rare condition that is frequently misdiagnosed. Histological analysis and fungal culture are used to make a definitive diagnosis. The purpose of this study is to discuss a case of COVID-19-induced aspergillosis involving the maxillary sinus in an immunocompromised patient, with a focus on early diagnosis because fungi have a predisposition to invade nearby blood vessels and embolize to distant organs, making a delay in treatment which is life-threatening., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Rai et al.)

Viruses have been implicated in the causation of several systemic illnesses, either directly or by immune modulation. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not an exception. Due to altered immune regulation, it is often associated with novel clinical manifestations and complications which have not been reported before. SARS-CoV-2 induces a pro-inflammatory state which makes the patient vulnerable to developing a variety of previously unreported adverse reactions to medications. Coronavirus disease 2019 (COVID-19) and its treatment have provided a fertile ground for various opportunistic infections including mucormycosis. The standard treatment for mucormycosis is surgical debridement and liposomal amphotericin B. Triazole antifungals such as posaconazole and isavuconazonium are the second-line agents for those intolerant to first-line therapy. Posaconazole is safer than amphotericin B as far as renal adverse effects are concerned. We report the case of a 60-year-old lady with type 2 diabetes mellitus, hypertension, ischemic heart disease, and osteoarthritis. She had severe COVID-19 requiring non-invasive ventilation four months ago. She presented with right rhino-orbital swelling, diplopia, and serosanguinous discharge from the right nostril. She had right third, sixth, and seventh cranial nerve palsies. Magnetic resonance imaging revealed right maxillary, ethmoid, and frontal sinusitis. Biopsy from the right nostril confirmed mucormycosis. Having normal renal and liver functions, she was started on oral posaconazole as she had an allergic reaction to a test dose of 1 mg amphotericin B (non-liposomal) in 20 mL of 5% dextrose water infused over 30 minutes. On day five, she developed acute kidney injury requiring renal replacement therapy. Her posaconazole was stopped. As she was not improving with conservative treatment, an ultrasound-guided, percutaneous renal biopsy was performed from the left kidney. The renal biopsy revealed thrombotic microangiopathy. She was started on liposomal amphotericin B as decided by the multidisciplinary team. Her renal function improved, and she continued on liposomal amphotericin B. We conclude that thrombotic microangiopathy, in this case, was likely due to posaconazole. This is a novel adverse effect presumably of posaconazole. This case report will alert physicians to be vigilant of the renal adverse effects of posaconazole in patients who have had COVID-19. Patients who develop renal injury while on posaconazole should undergo an early renal biopsy to ascertain the exact histopathology., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Noor et al.)

Cavernous sinus thrombophlebitis is a rare, potentially life-threatening, condition that is most often caused by gram-negative bacteria and, to a lesser extent, fungi. Mucor is an opportunistic fungus that frequently affects patients with a weak immune system. We describe a case of an adult female without diabetes who developed Mucor sphenoid sinusitis causing cavernous sinus thrombophlebitis. The patient presented with headache, diplopia, and right lateral rectus palsy. Cranial magnetic resonance imaging (MRI) showed abnormal prominent enhancement involving the cavernous sinuses associated with interspersed internal non-enhancing components indicating bilateral cavernous sinus thrombophlebitis and exuberant inspissated secretions within the left sphenoid sinus. After administering enoxaparin and intravenous antibiotics, the patient underwent endoscopic transnasal sphenoidotomy with nasal polypectomy. Culture results showed growth of mucor, for which the patient received itraconazole. Thereafter, complete resolution of headache, diplopia, and right lateral rectus palsy was observed. On follow-up, no residual neurologic deficits were noted. The repeat cranial MRI showed no abnormality involving the cavernous sinuses, with no evidence of cavernous sinus thrombophlebitis and normal paranasal sinuses. While a few case reports have been available on cavernous sinus thrombophlebitis caused by fungal sphenoid sinusitis with Mucor as the primary organism, none have involved immunocompetent individuals., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Nunez et al.)

Chronic allergic rhinosinusitis is a debilitating condition in a group of susceptible individuals with multifactorial etiology. I present my case of suffering from chronic allergic rhinosinusitis for 25 years treated with multiple drugs and surgeries with no relief. Adjunctive daily saline nasal douching has provided significant relief for three years to date. Genetic susceptibility with defective ciliary clearance, mucosal metaplasia with increased goblet cells secreting thick and inspissated mucus blocking the normal drainage, and stasis of secretions with inadequate mucosal immunity predisposes to polymicrobial infections, including fungal infections, antimicrobial resistance, and recurrent episodes of rhinosinusitis. Medical and surgical strategies often fail to manage this condition appropriately in a few cases. Adjunctive daily saline nasal douching is a safe and effective alternative to manage the debilitating symptoms of chronic allergic rhinosinusitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Lakkireddy et al.)