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[Invasive nasosinusal aspergillosis in an immunocompetent patient]
G Paludetti1, M Rosignoli, E Ferri
1Istituto di Clinica Otorinolaringoiatrica, Università Cattolica del Sacro Cuore, Policlinico Universitario A. Gemelli, Roma.
Abstract:
The authors describe a case of invasive nasosinusal aspergillosis in an immunocompetent patient. After a careful bibliographic review, they emphasize that in the present case the diagnosis was made by means of fungal culture as the clinical picture, imaging techniques and histopathological findings were aspecific. The pathogenetic agent resulted Aspergillus tamarii which belongs to the Aspergillus flavus group and is one of the most unusual agents in literature. The treatment of choice, in the invasive form, is surgery that should be as radical as possible followed by a medical therapy. In the present case, after two-phase radical surgery on all the paranasal sinuses, medical treatment with traconazole was employed with excellent local results at a follow-up of one year.
Insights
This case study highlights invasive nasosinusal aspergillosis caused by Aspergillus tamarii in an immunocompetent individual. Early diagnosis via fungal culture and aggressive surgical intervention followed by antifungal therapy proved effective.
Area of Science:
- Mycology
- Infectious Diseases
- Otolaryngology
Background:
- Invasive nasosinusal aspergillosis is rare, particularly in immunocompetent patients.
- Diagnosis can be challenging due to non-specific clinical and imaging findings.
- Aspergillus tamarii is an uncommon pathogen in human infections.
Observation:
- A case of invasive nasosinusal aspergillosis in an immunocompetent patient is presented.
- Diagnosis was confirmed by fungal culture, as clinical, imaging, and histopathological data were inconclusive.
- The causative agent identified was Aspergillus tamarii, a rare member of the Aspergillus flavus group.
Findings:
- Fungal culture is crucial for definitive diagnosis when other methods are non-specific.
- Aggressive surgical debridement is the primary treatment for invasive forms.
- Combined surgical and medical management with voriconazole achieved excellent outcomes.
Implications:
- This case underscores the importance of considering unusual fungal pathogens in immunocompetent hosts.
- Highlights the diagnostic utility of fungal cultures in complex sinonasal infections.
- Demonstrates the efficacy of radical surgery and targeted antifungal therapy for invasive aspergillosis.