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Multiple intracranial mucoceles associated with phaeohyphomycosis of the paranasal sinuses
J E Aviv1, W Lawson, E J Bottone
1Department of Otolaryngology, Mount Sinai Medical Center, New York, NY 10029.
Abstract:
The purpose of this article is to alert clinicians to a new pathogenic fungus of the paranasal sinuses called Exserohilum rostratum. Exserohilum species are one of the etiologic agents of phaeohyphomycosis, a constellation of entities caused by dematiaceous fungi. This class of fungal sinus infection has emerged only in the past decade; it occurs primarily in immunocompetent individuals and produces a tenacious, progressive pansinusitis. To our knowledge, this study describes the first case of multiple intracranial mucoceles secondary to E rostratum. The diagnostic workup includes computed tomography and magnetic resonance imaging followed by direct microscopic examination of tissue biopsy specimens. A craniotomy followed by a bilateral external ethmoidectomy was necessary for complete extirpation of the infected mucoceles. Aggressive surgical management of this mycotic infection is described.
Insights
This study highlights Exserohilum rostratum as a new fungal pathogen causing paranasal sinus infections, leading to intracranial mucoceles. Aggressive surgical intervention is crucial for managing this rare mycotic infection.
Area of Science:
- Mycology
- Infectious Diseases
- Neurosurgery
Background:
- Phaeohyphomycosis is a fungal infection caused by dematiaceous fungi.
- Fungal sinus infections have emerged in the last decade, primarily affecting immunocompetent individuals.
- Exserohilum species are identified as etiologic agents of phaeohyphomycosis.
Observation:
- A novel pathogenic fungus, Exserohilum rostratum, has been identified in paranasal sinus infections.
- This fungus can cause tenacious, progressive pansinusitis.
- The study reports the first instance of multiple intracranial mucoceles secondary to E. rostratum.
Findings:
- Diagnostic workup involved computed tomography (CT) and magnetic resonance imaging (MRI).
- Direct microscopic examination of tissue biopsy specimens confirmed the fungal presence.
- Complete extirpation of infected mucoceles required craniotomy and bilateral external ethmoidectomy.
Implications:
- Clinicians should be aware of Exserohilum rostratum as a potential cause of fungal sinusitis.
- Early and aggressive surgical management is essential for successful treatment of E. rostratum-induced intracranial mucoceles.
- This case expands the spectrum of clinical manifestations associated with dematiaceous fungal infections.