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Allergic fungal sinusitis associated with Trichoderma longibrachiatum
Patrick Tang1, Subhash Mohan, Lynne Sigler
1Department of Microbiology, Toronto Medical Laboratories and Mount Sinai Hospital, Toronto, Ontario, Canada.
Journal of Clinical Microbiology
|November 8, 2003
Summary
Allergic fungal sinusitis caused by Trichoderma longibrachiatum can be successfully treated. Careful microscopic examination is crucial to avoid misidentifying fungal elements like chlamydospores.
Area of Science:
- Mycology
- Immunology
- Otolaryngology
Background:
- Allergic fungal sinusitis (AFS) is an inflammatory condition of the sinuses.
- It is often associated with atopy and asthma.
- Diagnosis can be challenging due to potential misidentification of fungal elements.
Observation:
- A case of AFS caused by Trichoderma longibrachiatum is presented.
- Initial Gram stain of sinus biopsy was misinterpreted as yeast.
- Fungal structures were correctly identified as chlamydospores after culture.
Findings:
- Trichoderma longibrachiatum was identified as the causative agent.
- Successful management involved sinus lavage, corticosteroids, itraconazole, and immunotherapy.
- Accurate identification of fungal structures is critical for diagnosis.
Implications:
- This case highlights the importance of meticulous direct smear examination in diagnosing fungal sinusitis.
- It underscores the need for mycological culture in definitive identification.
- Effective multi-modal treatment strategies can lead to successful patient outcomes.