In October of the same year he was readmitted
because of persistence of symptoms and increase
in size of the left paranasal skin nodule. Anterior
and posterior rhinoscopy disclosed a severe granulomatous
process in the mucosa, and it was de
cided to perform an exploratory Caldwell-Luc
procedure on the left side. The maxillary antrum
was filled with sero-mucous, granular material
and there were areas of thickened and ulcerated mucosa. A subtotal resection of the middle and
inferior turbinate was performed. Tissue sections
from this material and the mucosa showed many
areas with a prominent chronic inflammation, as
sociated with multinucleated giant cells, and se vere infiltration by eosinophils. Many large non- septate hyphae were seen, surrounded by a bright
granular eosinophilic material. This material as well as the wall of the hyphae were F.A.S. posi
tive. The Grocott stain also demonstrated thedark staining of the wall of the fungus (Fig. 2).
Once the diagnosis of rhinoentomophthoromycosis
was made by tissue sections, attempts to cul
ture the fungus from the surgical gauze packing
of the maxillary antrum was attempted, but gave
negative results. The patient refused an attempt
to biopsy the paranasal nodule in order to perform
cultures from fresh tissue. He was then initiated
on iodides and discharged from the hospital in
general good condition. He was seen for the last
time in April 1980 with persistence of the left paranasal
skin nodule.