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Fungal sinusitis: progression of disease in immunosuppression--a case report
A Gungor1, V Adusumilli, J P Corey
1Department of Surgery, University of Chicago, IL 60637, USA.
Abstract:
Fungal sinusitis is a disease which can be grouped into invasive and noninvasive forms. The invasive entities include the acute/fulminant and chronic/indolent forms. The noninvasive entities include the fungus ball and allergic forms. The noninvasive forms, however, can develop into invasive disease under certain immunosuppressive states. The patient in this case report had the fungus ball form of fungal sinusitis which evolved into chronic, and then the acute/fulminant form approximately two weeks after undergoing cadaver-donor kidney transplantation. Due to the patient's immunosuppressed state, the fungus spread beyond the sinus region and eventually lead to fulminant disseminated disease. The severity of the fungal disease corresponded directly to the severity of the patient's immunosuppression.
Insights
Fungal sinusitis, initially noninvasive, can become invasive in immunocompromised patients. This case shows fungal sinusitis progressing to disseminated disease post-kidney transplant due to immunosuppression.
Area of Science:
- Mycology
- Immunology
- Transplant Surgery
Background:
- Fungal sinusitis presents as invasive (acute/fulminant, chronic/indolent) or noninvasive (fungus ball, allergic) forms.
- Noninvasive fungal sinusitis can progress to invasive disease, particularly in immunosuppressed individuals.
Observation:
- A kidney transplant recipient developed fungal sinusitis, initially as a fungus ball.
- The condition evolved into chronic and then acute/fulminant invasive fungal sinusitis approximately two weeks post-transplant.
Findings:
- The patient's immunosuppressed state post-transplant facilitated fungal spread beyond the sinuses.
- This led to acute/fulminant disseminated fungal disease.
Implications:
- The severity of invasive fungal sinusitis correlates with the degree of patient immunosuppression.
- Close monitoring for invasive fungal infections is crucial in transplant recipients with immunosuppressive therapy.