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Breakthrough Acute Necrotizing Invasive Fungal Rhinosinusitis by Alternariaalternata in a Patient with Acute
Giorgos Tyrellis1, Maria Siopi2, Danai Leventakou3
12nd Otolaryngology Department, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Abstract:
Alternaria spp. have emerged as opportunistic pathogens particularly in immunosuppressed patients. A case of a breakthrough acute invasive fungal rhinosinusitis (AIFRS), caused by Alternaria alternata, is reported in a patient with acute lymphoblastic leukemia (ALL) on anidulafungin therapy, who was successfully treated with liposomal amphotericin B and surgical intervention. To date, 20 cases of AIFRS due to Alternaria spp. have been described, 19 in the USA and 1 in Chile, making this case report the first case of AIFRS due to Alternaria in Europe. The patients had median (range) age 25 (2-56) years (65% female), almost all of them (19/20) with hematological diseases and severe neutropenia (8-41 days pre-infection). Amphotericin B was the most frequently used antifungal agent, either alone or in combination. In all of the cases, systemic antifungal therapy was combined with surgery. Despite stabilization or improvement of the AIFRS, mortality was 38% (5 days to 8 months post-surgical debridement) due to their underlying disease or other infections without sign of AIFRS at autopsy.
Insights
This case report details a rare fungal infection, acute invasive fungal rhinosinusitis (AIFRS), caused by Alternaria alternata in an acute lymphoblastic leukemia patient. Successful treatment involved liposomal amphotericin B and surgery, highlighting a new European case.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Opportunistic fungal infections by Alternaria species are increasing, especially in immunocompromised individuals.
- Acute invasive fungal rhinosinusitis (AIFRS) is a severe complication.
- Patients with hematological malignancies and neutropenia are at high risk.
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