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Scedosporium Sinusitis: A Rare Opportunistic Infection.
Saipriya Ayyar1, Rebekah Lantz2, Asif Khan3
1Boonshoft School of Medicine, Wright State University, Dayton, USA.
Cureus
|September 15, 2023
Summary
Scedosporium sinusitis, a challenging fungal infection, was successfully treated in an immunocompromised patient with HIV, diffuse large B cell lymphoma, and hemophagocytic lymphohistiocytosis. Surgical debridement combined with voriconazole resolved the invasive fungal sinusitis.
Area of Science:
- Mycology
- Infectious Diseases
- Oncology
Background:
- Scedosporium sinusitis is an opportunistic infection in immunocompromised individuals, often resistant to antifungals.
- Hematologic malignancies and neutropenia increase susceptibility to Scedosporium sinopulmonary disease.
- Invasive fungal sinusitis presents a significant therapeutic challenge due to antifungal resistance.
Observation:
- A 38-year-old male with HIV, diffuse large B cell lymphoma (DLBCL), and hemophagocytic lymphohistiocytosis (HLH) presented with facial pain and fever.
- Maxillofacial CT revealed fungal sinusitis involving the sphenoid and maxillary sinuses.
- Endoscopic debridement confirmed Scedosporium fungal growth.
Findings:
- Surgical intervention included debridement, medial maxillectomy, and ethmoidectomy.
- A three-month course of voriconazole was administered with regular liver enzyme monitoring.
- The patient achieved resolution of the Scedosporium sinusitis.
Implications:
- This case highlights successful management of refractory Scedosporium sinusitis in a complex immunocompromised patient.
- Aggressive surgical and antifungal therapy can overcome treatment challenges posed by Scedosporium infections.
- Early diagnosis and multidisciplinary management are crucial for favorable outcomes in invasive fungal sinusitis.
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