Olfactory cleft infection revealed by anosmia

Excerpt

A 24-year-old oenologist was admitted for anosmia following SARS-CoV-2 infection confirmed by RT-PCR. He had no particular medical history and was not taking any medications long-term. Nasofibroscopic examination revealed a normal left nasal fossa and edema of the right olfactory cleft (OC) with a polypoid aspect (Fig. 1A, arrow). Severe hyposmia was confirmed with a total score of 14/32 with the European Test of Olfactory Capabilities [1] (E.T.O.C). Computed tomography of the skull base revealed an OC mass (Fig. 1B, arrow). Contrast-enhanced T2-weighted magnetic resonance imaging revealed a dark signal in the OC with a high signal in surrounding soft tissue, indicating hypertrophic mucosal walls (Fig. 1C, arrow). Endoscopic right sinus surgery was performed to remove the abscess, free the OC and perform biopsies [2]. Histological analysis confirmed the presence of filamentous bacteria grains around a sinusal foreign plant body, characteristic of Actinomyces (Grocott positive, Gram positive and Ziehl negative) (Fig. 2), DNA extraction was performed followed by an Actinomyces-specific PCR and the final integrated histo-molecular diagnosis was a chronic sinusitis due to Actinomyces odontolyticus/meyeri also known as Actinomycosis. The patient was discharged to home and received an oral course of amoxicillin clavulanic acid for 10 days (1 g three times a day). At 1 month postoperatively, the patient had already experienced recovery of his olfactory capabilities (ETOC total score of 24/32 (mild hyposmia)). Actinomycosis is a chronic infection caused by anaerobic pseudofilamentous bacteria or fungi. Considering the lack of information about this disease in the paranasal sinuses, especially in nonendemic areas, it is of high importance to enhance the awareness of clinicians, especially with infections varying widely in presentation and extent of disease.

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