Mixed etiology COVID-19 associated acute rhinosinusitis caused by two Aspergillus species
Payam Tabarsi1, Somayeh Sharifynia1, Mihan Pourabdollah Toutkaboni2
1Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Introduction:
Acute invasive fungal rhino-sinusitis (AIFR) is a life-threatening infection that is mostly found in immunocompromised patients with serious morbidity and mortality. Recently, reports of AIFR have also emerged among SARS-CoV-2 infected patients.
Case Presentation:
A 50-year-old diabetic woman, previously diagnosed with COVID-19 pneumonia, was presented to the hospital with left facial pain on day 12 after discharge. Paranasal sinuses computed tomography was performed and according to the mucosal thickening in both maxillary sinuses and ethmoidal air cells, the patient underwent functional endoscopic sinus surgery (FESS) and necrosis were observed. The histopathologic examination revealed mycelium with septation suspected to Aspergillus and the culture was consistent with Aspergillus flavus and also Aspergillus niger . We reported a case of COVID-19 associated AIFR with two combined Aspergillus species from Iran. The patient received liposomal amphotericin B, which then switched to voriconazole combined with aggressive surgical debridement of necrotic tissues with a clinically favorable outcome.
Conclusion:
Mixed etiology AIFR can influence the outcome. However, further investigation is required upon this new threat.
Insights
This case study highlights a rare instance of invasive fungal rhino-sinusitis (AIFR) in a COVID-19 patient, caused by a mixed Aspergillus infection. Prompt treatment involving surgery and antifungals led to a favorable outcome.
Area of Science:
- Mycology
- Infectious Diseases
- Otolaryngology
Background:
- Acute invasive fungal rhino-sinusitis (AIFR) is a severe infection primarily affecting immunocompromised individuals.
- Emerging reports indicate a potential link between SARS-CoV-2 infection and AIFR.
- This underscores the need to consider AIFR in patients with a history of COVID-19.
Observation:
- A 50-year-old diabetic woman, recovering from COVID-19 pneumonia, presented with facial pain.
- CT scans revealed sinus mucosal thickening, leading to functional endoscopic sinus surgery (FESS).
- Histopathology identified septate mycelia, and cultures confirmed a mixed infection of Aspergillus flavus and Aspergillus niger.
Findings:
- The patient was diagnosed with COVID-19 associated AIFR caused by two combined Aspergillus species.
- Treatment involved liposomal amphotericin B, followed by voriconazole, and aggressive surgical debridement.
- A clinically favorable outcome was achieved despite the mixed fungal etiology.
Implications:
- Mixed fungal infections in AIFR can impact patient outcomes.
- This case highlights a potential new threat associated with COVID-19.
- Further research is warranted to understand and manage AIFR in the context of SARS-CoV-2 infection.
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