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Alternaria sinusitis
Abstract:
Alternaria is a fungus of the class Deuteromycetes and the family Dematiaceae. Fungi of this genus have generally been regarded as nonpathogenic and as contaminants when isolated from clinical specimens. Hypersensitivity to Alternaria spores, however, has long been recognized as a cause of allergic pulmonary disease. More recently, the organism has also been demonstrated to have potential for opportunistic invasion of immunosuppressed and debilitated patients. Presented is a case in which this organism was repeatedly isolated from naso-oral tissue specimens from an otherwise healthy patient. The organism was seen in biopsies from a granulomatous hyperplastic destructive disease of the maxilla and soft tissues of the face which extended to the ethmoid sinus and fistulized through the hard palate. The clinical course, pathophysiology and therapeutic approach are discussed. The management of this disease requires a multidisciplinary approach involving the otolaryngologist, infectious disease specialist and pathologist.
Insights
Alternaria, a fungus, can cause destructive naso-oral disease in healthy individuals, not just allergic reactions or opportunistic infections. This case highlights its potential for invasive granulomatous infections.
Area of Science:
- Mycology
- Immunology
- Pathology
Background:
- Alternaria fungi are typically considered nonpathogenic contaminants in clinical settings.
- Hypersensitivity to Alternaria spores is a known cause of allergic pulmonary disease.
- Recent evidence suggests Alternaria can opportunistically invade immunocompromised individuals.
Observation:
- This report details a case of invasive Alternaria infection in an otherwise healthy patient.
- The fungus was repeatedly isolated from naso-oral tissue specimens.
- Biopsies revealed granulomatous, hyperplastic, and destructive disease affecting the maxilla, facial soft tissues, ethmoid sinus, and palate.
Findings:
- Alternaria species can cause severe, destructive granulomatous disease in immunocompetent hosts.
- The infection presented as a rapidly progressing, fistulizing lesion.
- Histopathology confirmed fungal invasion and a significant inflammatory response.
Implications:
- This case expands the known clinical spectrum of Alternaria infections.
- It underscores the importance of considering fungi in destructive inflammatory conditions of the head and neck.
- Management necessitates a multidisciplinary approach involving otolaryngology, infectious diseases, and pathology.