Isolated Nasal Septum Necrosis Caused by Aspergillus flavus in an Immunocompromised Child

Abstract

Non-traumatic isolated nasal septal aspergillosis in the absence of sinusitis is a rare but serious infection in immunocompromised patients. Adequate management requires early diagnosis, prompt empiric antifungal therapy, and surgical debridement to prevent progression to life-threatening complications. With the increasing population of immunocompromised children, it is essential for timely management that clinicians have a high index of suspicion for this unusual presentation of aspergillosis.

Invasive Aspergillosis Associated Bacterial Infection in the Nasal Septum After Sphenoid Sinus Surgery

“…2) Fungal nasal septal abscess is not frequently encountered and has rarely been documented, with only a small number of foreign case reports or experiences published. [2][3][4][5] There are two previous reported cases in Korea. 6,7) Most previous fungal nasal septal abscess cases in immunocompromised patients spontaneously occurred.…”

“…6,7) Most previous fungal nasal septal abscess cases in immunocompromised patients spontaneously occurred. [3][4][5][6][7] One case happened in an immunocompetent patient who had under- Fig. 3.…”

“…10) In addition, atypical infection should be suspected if the patient does not respond to standard treatment measures. 5) If a patient is immunocompromised, invasive fungal infection including polymicrobial infection should be considered as part of the differential diagnosis. [2][3][4][5] Hematologic malignancies, aplastic anemia, long-term steroid use, acquired immunodeficiency syndrome, uncontrolled DM, and diseases of iron metabolism and immunosuppressive therapy for organ transplantation are the most commonly encountered underlying conditions.…”

“…5) If a patient is immunocompromised, invasive fungal infection including polymicrobial infection should be considered as part of the differential diagnosis. [2][3][4][5] Hematologic malignancies, aplastic anemia, long-term steroid use, acquired immunodeficiency syndrome, uncontrolled DM, and diseases of iron metabolism and immunosuppressive therapy for organ transplantation are the most commonly encountered underlying conditions. 10) In our case, although there was no necrosis of the septal mucosa, the patient was immunocompromised due to DM and CRF, and didn't respond adequately to broad spectrum antibiotics and daily dressing treatment.…”