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Invasive fungal pharyngitis in a pediatric bone marrow transplant patient
Andrew J Redmann1,2, Charles M Myer3,4, Pooja Khandelwal5
1ENT and Facial Plastic Surgery, Children's of Minnesota, Minneapolis, MN, USA.
Insights
Invasive fungal pharyngitis is a rare but serious infection in immunocompromised children. Early diagnosis and aggressive treatment, including surgery and antifungals, can lead to excellent outcomes, even in complex cases.
Area of Science:
- Mycology
- Infectious Diseases
- Pediatric Medicine
Background:
- Invasive fungal infections (IFD) of the head and neck are life-threatening, particularly in immunocompromised individuals.
- Prognosis for IFD is often poor despite combined surgical and medical interventions.
- The sinonasal region is the most common site for IFD in the head and neck.
Observation:
- A 10-year-old female with aplastic anemia post-bone marrow transplant presented with symptoms initially diagnosed as a peritonsillar abscess.
- Cultures from the site revealed Rhizopus species, indicating invasive fungal pharyngitis.
- The patient had undergone immunosuppressive therapy, increasing her susceptibility to fungal infections.
Findings:
- The pediatric patient was successfully treated with aggressive surgical debridement and antifungal therapy.
- The patient achieved an excellent functional outcome 2 years post-treatment.
- This case highlights successful management of a rare presentation of invasive fungal disease.
Implications:
- Alternative head and neck sites for invasive fungal disease should be considered in immunocompromised patients with atypical symptoms.
- Prompt diagnosis and multimodal treatment are crucial for improving outcomes in pediatric IFD.
- This case underscores the importance of considering fungal infections beyond the sinonasal area in at-risk populations.
Abstract:
Invasive fungal disease of the head and neck is a potentially fatal infection most commonly seen in immunocompromised patients. Even in the setting of combined surgical and medical treatment, prognosis is generally poor. We report the first pediatric case of invasive fungal pharyngitis and summarize a review of the literature. A 10-year-old female patientwith aplastic anemia status post-bone marrow transplant and accompanying immunosuppression initially presented with a diagnosis of a peritonsillar abscess. Incision and drainage did not show purulence, but culture grew out Rhizopus species. Immediately after diagnosis, the patient was treated successfully with aggressive staged surgical debridement and antifungal medications and had an excellent functional outcome 2 years after initial presentation. Invasive fungal disease is most common in the sinonasal region, but alternative sites of disease must be considered in immunocompromised patients who present with atypical symptoms.
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