Invasive Fungal Sinusitis Caused by Pseudallescheria Boydii: Case Report and Literature Review

Abstract

Funga l sinu sitis secondary to Pseudallescheria boydii is rare, as only 25 cases hav e been previously reported in the literature. Although Pboydii resembles Aspergillus on pathologic examination, it is typically resistant to amphotericin B. Therefore, culture is necessary to differentiate the two. Pati ents with P boydii sinusitis should generally be treat ed with a combination of surgery and antifungal therapy. Combination treatment is particularly important for immunocompromised pati ents with fungal invasion because morta lity among these patients is high. The prognosis is better for immunocompetent patients, even those with fungal invasion. We desc ribe a new case of invasive fungal sinusitis secondary to P boydii infection , and we review the literature on this emerging pathogen.

Successful Treatment of Scedosporium Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management

“…7,9,14 The invasive form of Scedosporium sinusitis is mostly limited to patients with hematologic malignancy, neutropenia, uncontrolled diabetes, or immunosuppression, although it has been occasionally reported in patients without underlying disorders. 1,6,13,[15][16][17][18] It is necessary to distinguish between sinus colonization and invasive fungal infection, such as in Case 2. Surgical debridement and reducing immunosuppression when feasible are key elements in the treatment strategy of invasive fungal sinusitis, in addition to combination antifungal therapy tailored to minimum inhibitory concentration (MIC) results.…”

“…4 Surgical intervention has previously been shown to have good curative effect in S. apiospermum sinusitis in immunocompetent patients and those compromised by hematologic malignancies, diabetes, and AIDS. 6 After double lung transplantation, there is a high mortality, up to 91%, in patients with Scedosporium pulmonary infections. 8,9 Early onset pulmonary Scedosporium infections following transplantation are associated with increased mortality compared to infection after the first year of transplant.…”

“…1,2 Diagnosis is difficult as Scedosporium has a similar appearance to other hyaline molds, such as Aspergillus or Fusarium , on pathology. 1,5,6 Culture is necessary both for identification and susceptibilities, but even on culture, the species is frequently not recognized due to its morphological plasticity. 1,5 Treatment of Scedosporium infections is especially challenging due to their resistance to many antifungals.…”

Successful prevention of scedosporiosis after lung transplantation in a cystic fibrosis patient by combined local and systemic triazole therapy

“…Being aware of the high mortality associated with S. apiospermum in patients after DLTx and the poor penetration of paranasal sinuses with systemic antifungal therapy, we opted for a more aggressive therapeutical approach. Surgical intervention had previously shown good curative effects in S. apiospermum sinusitis [12] . However, even with combined surgery and systemic antifungal treatment the overall prognosis after invasive fungal sinusitis in immunocompromised hosts is still poor, with a mortality rate of 84% [12] .…”

“…Surgical intervention had previously shown good curative effects in S. apiospermum sinusitis [12]. However, even with combined surgery and systemic antifungal treatment the overall prognosis after invasive fungal sinusitis in immunocompromised hosts is still poor, with a mortality rate of 84% [12]. Therefore, we performed simultaneous intraoperative lavages with voriconazole, continuing for 2 weeks postoperatively via external drainages.…”