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Curvularia/Drechslera sinusitis
S M Killingsworth1, S J Wetmore
1Department of Otolaryngology-Head & Neck Surgery, University of Arkansas for Health Sciences, Little Rock.
Abstract:
Sinusitis due to unusual fungal pathogens is thought to occur primarily in immunocompromised individuals. However, the fungi Curvularia, Drechslera, and others produce sinusitis in healthy young adults. The signs and symptoms produced by these organisms are usually considered to be complications of sinusitis. Of the three cases that we report, two manifested decreased visual acuity, and the third presented with acute onset of seizures. Computed tomography scans were helpful in delineating the extent of disease and in following the results of therapy. Aggressive surgical treatment is necessary; indeed, two of our cases required a second operation to eradicate all disease. If histopathology shows tissue invasion by the fungus, intravenous amphotericin B is recommended. Fungal cultures and smears should be obtained when healthy patients present with complications of sinusitis.
Insights
Unusual fungal sinusitis can affect healthy adults, causing serious complications like vision loss and seizures. Early diagnosis and aggressive surgical treatment are crucial for recovery.
Area of Science:
- Mycology
- Infectious Diseases
- Otolaryngology
Background:
- Fungal sinusitis is typically associated with immunocompromised individuals.
- Uncommon fungal pathogens can cause sinusitis in immunocompetent hosts.
Observation:
- Three cases of sinusitis caused by Curvularia and Drechslera in healthy young adults are presented.
- Symptoms included decreased visual acuity and acute onset of seizures.
- Computed tomography (CT) scans aided in disease assessment and treatment monitoring.
Findings:
- Aggressive surgical intervention is essential for managing invasive fungal sinusitis.
- Two of the three reported cases required repeat surgeries for complete disease eradication.
- Histopathological confirmation of fungal invasion warrants intravenous amphotericin B treatment.
Implications:
- Clinicians should consider fungal cultures and smears in healthy patients presenting with sinusitis complications.
- Prompt and aggressive management can lead to favorable outcomes even in severe cases.
- This highlights the importance of considering non-invasive fungal sinusitis in immunocompetent individuals.