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Infectious Diseases

Headache and infection

01/14/2002

Question:

I have a long history of chronic,deep,cranio- facial pain with sinus involvement. I have swelling on the right side of my head with tinnitis. The pain is constant, and gets worse with any type of head congestion- it actually feels inflamed when I breath (on the right side).I have had a number of sinus surgeries (ethmoidectomy,maxillary anstrostomy, caldwell-luc).And my sinus looks normal now- but the headaches never cease. They found an Aspergillus fungal ball in the maxillary,which was removed,and a biopsy of that area showed no tissue involvement. But could there be some type of deeper fungal (or bacterial) bone or tissue infection? Nothing shows up on the MRI,or MRA, but blood tests showed low reticulocytes,hemoglobin, and hematocrit values,and positive ANA (1:40). I`ve had this head pain for decades, but within the last year,it has gotten worse,and the tinnitus started. I`ve had the ear checked out-no tumors. I`ve been to numerous specialists, but none have been able to determine its cause- they don`t think it`s an auto-immune thing,or migraine thing,or neurologic problem.It`s definitely an unusual case! I was thinking of seeing a physician of infectious disease it there`s any chance this could be a possible cause. Thank you for your time.

Answer:

Aspergillus fungus balls of the sinus can be troublesome, but they rarely cause invasive disease. There are bacteria that can cause invasive disease of the sinuses like Pseudomonas, but given your prolonged history of pain, it is most likely that any bone invasion would have developed within weeks not years.

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Response by:

George S Deepe, Jr, MD George S Deepe, Jr, MD
Professor of Clinical Medicine
Director of Infectious Diseases
College of Medicine
University of Cincinnati