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Scedosporium apiospermum invasive sinusitis presenting as extradural abscess

N Khoueir1, B Verillaud2, P Herman2

  • 1Département d'otorhinolaryngologie/chirurgie cervico-faciale/chirurgie de la base du crâne, université Paris-Diderot, hôpital Lariboisière, AP-HP, Paris, France; Département d'otorhinolaryngologie/chirurgie cervico-faciale, hôpital universitaire Hôtel-Dieu de France, université Saint Joseph, faculté de médecine, Beirut, Lebanon.

European Annals of Otorhinolaryngology, Head and Neck Diseases
|December 12, 2018
PubMed
Abstract

Insights

This case study highlights Scedosporium apiospermum chronic invasive fungal rhinosinusitis (CIFR) in an immunocompetent patient. Surgery alone proved sufficient, suggesting it may be adequate for immunocompetent individuals with this rare fungal infection.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Otolaryngology

Background:

  • Chronic invasive fungal rhinosinusitis (CIFR) is rare, typically affecting immunocompromised individuals.
  • Aspergillus species are the most common pathogens identified in CIFR.
  • Imaging in CIFR often shows invasive pseudoneoplastic features.

Observation:

  • A 72-year-old immunocompetent male presented with chronic headache, neck pain, and limited eye movement.
  • Imaging revealed an isolated left sphenoid lesion with bone changes and an extradural abscess.
  • Histological examination and fungal culture confirmed Scedosporium apiospermum CIFR.

Findings:

  • Scedosporium apiospermum is an uncommon cause of CIFR.
  • The patient exhibited an atypical presentation with isolated sphenoid infection, abducens nerve paralysis, and extradural abscess.
  • Radiological findings mimicked fibrous dysplasia or bacterial osteomyelitis, deviating from typical CIFR imaging.

Implications:

  • Surgical treatment alone may be sufficient for immunocompetent patients with S. apiospermum CIFR.
  • This case expands the understanding of atypical presentations and imaging findings in CIFR.
  • Highlights the importance of considering rare fungal pathogens in complex sinonasal infections.
Keywords:
Extradural abscessInvasive fungal rhinosinusitisSphenoidal sinus

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