A Case of Allergic Fungal Sinusitis Caused by Bipolaris spicifera

Abstract

We describe a case of allergic fungal sinusitis (AFS) caused by Bipolaris spicifera, the first case reported in Japan. A 70-year-old man was admitted to our hospital because of diplopia following bilateral nasal obstruction and discharge. Radiological studies using computed tomographic scan showed a large soft tissue mass occupying the right frontal, bilateral ethmoid and sphenoid sinuses. He underwent drainage surgery and histopathological examination of the contents of the paranasal sinuses revealed scattered fungal hyphae within "allergic mucin". By cytological examination, these hyphae showed septation at irregular intervals, and were swollen to various sizes. Microbiological studies identified the fungus as Bipolaris spicifera. The presence of allergic mucin and scattered fungal hyphae were very important findings in making a diagnosis of AFS histopathologically, so squash cytology of the contents of the paranasal sinuses was quite useful to observe fungal elements and identify the strain in this case.

Diversity of Bipolaris Species in Clinical Samples in the United States and Their Antifungal Susceptibility Profiles

“…These fungi are able to infect both immunocompetent and immunosuppressed patients, mainly in tropical and subtropical areas. The most common clinical presentations are allergic sinusitis, keratitis, endophthalmitis, onychomycosis, peritoneal dialysis-associated peritonitis, lung and skin infections, and, less frequently, central nervous system (CNS) infections (2,4,5,10,16,26,28,31).…”

Sinusitis and frontal brain abscess in a diabetic patient caused by the basidiomycete Schizophyllum commune: case report and review of the literature

“…These reports include mainly pulmonary manifestations such as bronchopneumonia, pulmonary nodules or fungal balls, allergic bronchopulmonary mycoses, bronchial mucoid impaction, and bronchogenous cysts. 5,[11][12][13][14][15][16][17][18][19] Brain involvement of S. commune infection has been reported once previously. In 1996 brain abscess formations and pulmonary nodules caused by S. commune were described by Rihs and colleagues.…”

“…After introduction of these new methods we found twelve isolates of this basidiomycetous fungus within a 3‐year‐period, all obtained from patients suffering from chronic sinusitis 10 . After introduction of nucleotide sequencing the frequency of S. commune isolation from clinical samples has increased 1,5–6,11–12,15,18,21,22 . Antifungal susceptibility testing has rarely been performed for S. commune.…”

“…10 After introduction of nucleotide sequencing the frequency of S. commune isolation from clinical samples has increased. 1,[5][6][11][12]15,18,21,22 Antifungal susceptibility testing has rarely been performed for S. commune. The use of the Etest method was preferred against microdilution methods (CLSI, EUCAST) because of the unproblematic availability of the test antimycotics and the ease of use of the method.…”

Molecular detection ofSchizophyllum communein a case of allergic fungal rhinosinusitis

“…Allergic fungal rhinosinusitis (AFRS) is mostly caused by Aspergillus 3. However, nowadays, rarely encountered species, for example, Schizophyllum commune , are also being reported in diseases such as pulmonary disorders, ulcerative lesions of the palate, cerebral abscess, onychomycosis and chronic and allergic sinusitis 4 5. Early diagnosis of AFRS prevents repeat courses of antibiotics and surgical procedures, however, criteria for the diagnosis are still evolving.…”