Case report: Fungal colonization of a mometasone-releasing implant after endonasal endoscopic pansinus revision

Introduction:

Follow-up treatment after sinus surgery includes -adapted to the clinical picture- antibiotic therapy as well as systemic and topical steroid therapy. A longer-term localized steroid drug delivery is desirable. In difficult cases frontal nasal stents are an option. The mometasone-releasing PROPEL® sinus stent is a self-expanding implant made of a polysaccharide polymer. The PROPEL® stent is deployed in the ethmoid sinuses. Its lattice structure is intended to ensure the preservation of local secretion drainage. In a rabbit model the stent material proved to be well tolerated. In a small proportion of animals fungal colonization was noted (Am J Rhinol Allergy 2009; 23:591 – 596).

Methods:

Due to chronic polypous sinusitis a 40-year-old patient underwent pansinus revision with Propel® stent insertion in both ethmoid sinuses. In the follow-up examination after 4 weeks with timely wound healing a fungal colonization was observed on stent scraps left behind in tissue of the left middle turbinate. A complete removal of stent scraps on the left side was exerted. In the follow-up examination a slightly polypous swelling of the mucous membrane in both ethmoid sinuses was seen without any further irritation.

Results/Conclusions:

To the best of our knowledge this is the first report from clinical practice of fungal colonization after PROPEL® stent insertion. Fungal colonization of a foreign material in the paranasal sinuses with ubiquitously occurring fungi is conceivable and was possibly enhanced by the localized steroid-releasing implant. Removal of the colonized stent scraps should allow unimpaired wound healing.

Publication History

Publication Date:
23 April 2019 (online)