Recurrent epistaxis, chronic pancytopenia and nasal mycosis

A 52-year-old man with chronic, profound pancytopenia associated with a four-year history of Waldenstrom's macroglobulinemia refractory to chemotherapy began to experience major epistaxes requiring hospital admission for control. A diagnosis of invasive Aspergillus was made on nasal mucosal biopsy. A regimen of bi-weekly intravenous and sixth-hourly topical amphotericin B drops with adjuvant rifampicin successfully eradicated local nasal pain as well as the epistaxis. Resolution of infection was documented by gallium scan. It is suggested that, in addition to the aggressive craniofacial mycoses already described, lower grade nasal mycoses occur. The roles of biopsy and gallium scan in immunocompromised hosts with epistaxis are discussed.