Limited superficial invasion as an early manifestation of acute invasive fungal sinusitis

Nicola M. Pereira; Samuel D. Racette; Daniel N Johnson; Sajal D Tanna; Stephanie Shintani Smith

doi:10.1016/j.xocr.2022.100458

Limited superficial invasion as an early manifestation of acute invasive fungal sinusitis

Nicola M. Pereira, Samuel D. Racette, Daniel N Johnson, Sajal D Tanna, Stephanie Shintani Smith^*

^*Corresponding author for this work

Otolaryngology

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: To describe a case of acute invasive fungal sinusitis (AIFS), unique in its presentation with limited superficial invasion, underlying a fungal crust, in a patient on antifungal prophylaxis. To present accompanying images and pathology results that capture the very early stages of fungal invasion and depict the ongoing battle between fungal organisms and the immune system. Methods: Case report with literature review. Results: We present the case of a 74-year-old immunocompromised male on prophylactic voriconazole who was admitted with neutropenic fever and was found to have superficially invasive fungal sinusitis. Pathology from the initial surgical debridement showed superficial invasion of the middle turbinate mucosa, but no angioinvasion. Biopsies from a second surgical debridement were negative for fungal organisms, but fungal cultures were positive. The patient was treated with amphotericin B and posaconazole and discharged with plans for likely lifelong posaconazole. Conclusion: This case augments the existing AIFS literature in that the histopathology uniquely demonstrates limited superficial invasion, underlying a fungal crust, likely portraying the early stages of AIFS. Additionally, this case highlights new and ongoing clinical questions surrounding AIFS prevention and diagnosis, particularly in immunocompromised patients.

Original language	English (US)
Article number	100458
Journal	Otolaryngology Case Reports
Volume	24
DOIs	https://doi.org/10.1016/j.xocr.2022.100458
State	Published - Sep 2022

Funding

Dr. Smith is supported by the Chronic Rhinosinusitis Integrative Studies Program grant from the National Institutes of Health (NIH), Bethesda, MD., USA, National Institute of Allergy and Infectious Diseases (NIAID) ( U19 AI106683 ). The funding organizations did not contribute to the design or conduct of this study, preparation, review, approval or decision to submit this manuscript for publication.

Keywords

Alternaria
Antifungal agents
Invasive fungal infections
Sinusitis

ASJC Scopus subject areas

Otorhinolaryngology

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10.1016/j.xocr.2022.100458

Cite this

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title = "Limited superficial invasion as an early manifestation of acute invasive fungal sinusitis",

abstract = "Objective: To describe a case of acute invasive fungal sinusitis (AIFS), unique in its presentation with limited superficial invasion, underlying a fungal crust, in a patient on antifungal prophylaxis. To present accompanying images and pathology results that capture the very early stages of fungal invasion and depict the ongoing battle between fungal organisms and the immune system. Methods: Case report with literature review. Results: We present the case of a 74-year-old immunocompromised male on prophylactic voriconazole who was admitted with neutropenic fever and was found to have superficially invasive fungal sinusitis. Pathology from the initial surgical debridement showed superficial invasion of the middle turbinate mucosa, but no angioinvasion. Biopsies from a second surgical debridement were negative for fungal organisms, but fungal cultures were positive. The patient was treated with amphotericin B and posaconazole and discharged with plans for likely lifelong posaconazole. Conclusion: This case augments the existing AIFS literature in that the histopathology uniquely demonstrates limited superficial invasion, underlying a fungal crust, likely portraying the early stages of AIFS. Additionally, this case highlights new and ongoing clinical questions surrounding AIFS prevention and diagnosis, particularly in immunocompromised patients.",

keywords = "Alternaria, Antifungal agents, Invasive fungal infections, Sinusitis",

author = "Pereira, {Nicola M.} and Racette, {Samuel D.} and Johnson, {Daniel N} and Tanna, {Sajal D} and Smith, {Stephanie Shintani}",

note = "Funding Information: Dr. Smith is supported by the Chronic Rhinosinusitis Integrative Studies Program grant from the National Institutes of Health (NIH), Bethesda, MD., USA, National Institute of Allergy and Infectious Diseases (NIAID) ( U19 AI106683 ). The funding organizations did not contribute to the design or conduct of this study, preparation, review, approval or decision to submit this manuscript for publication. Publisher Copyright: {\textcopyright} 2022",

year = "2022",

month = sep,

doi = "10.1016/j.xocr.2022.100458",

language = "English (US)",

volume = "24",

journal = "Otolaryngology Case Reports",

issn = "2468-5488",

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AU - Pereira, Nicola M.

AU - Racette, Samuel D.

AU - Johnson, Daniel N

AU - Tanna, Sajal D

AU - Smith, Stephanie Shintani

N1 - Funding Information: Dr. Smith is supported by the Chronic Rhinosinusitis Integrative Studies Program grant from the National Institutes of Health (NIH), Bethesda, MD., USA, National Institute of Allergy and Infectious Diseases (NIAID) ( U19 AI106683 ). The funding organizations did not contribute to the design or conduct of this study, preparation, review, approval or decision to submit this manuscript for publication. Publisher Copyright: © 2022

PY - 2022/9

Y1 - 2022/9

N2 - Objective: To describe a case of acute invasive fungal sinusitis (AIFS), unique in its presentation with limited superficial invasion, underlying a fungal crust, in a patient on antifungal prophylaxis. To present accompanying images and pathology results that capture the very early stages of fungal invasion and depict the ongoing battle between fungal organisms and the immune system. Methods: Case report with literature review. Results: We present the case of a 74-year-old immunocompromised male on prophylactic voriconazole who was admitted with neutropenic fever and was found to have superficially invasive fungal sinusitis. Pathology from the initial surgical debridement showed superficial invasion of the middle turbinate mucosa, but no angioinvasion. Biopsies from a second surgical debridement were negative for fungal organisms, but fungal cultures were positive. The patient was treated with amphotericin B and posaconazole and discharged with plans for likely lifelong posaconazole. Conclusion: This case augments the existing AIFS literature in that the histopathology uniquely demonstrates limited superficial invasion, underlying a fungal crust, likely portraying the early stages of AIFS. Additionally, this case highlights new and ongoing clinical questions surrounding AIFS prevention and diagnosis, particularly in immunocompromised patients.

AB - Objective: To describe a case of acute invasive fungal sinusitis (AIFS), unique in its presentation with limited superficial invasion, underlying a fungal crust, in a patient on antifungal prophylaxis. To present accompanying images and pathology results that capture the very early stages of fungal invasion and depict the ongoing battle between fungal organisms and the immune system. Methods: Case report with literature review. Results: We present the case of a 74-year-old immunocompromised male on prophylactic voriconazole who was admitted with neutropenic fever and was found to have superficially invasive fungal sinusitis. Pathology from the initial surgical debridement showed superficial invasion of the middle turbinate mucosa, but no angioinvasion. Biopsies from a second surgical debridement were negative for fungal organisms, but fungal cultures were positive. The patient was treated with amphotericin B and posaconazole and discharged with plans for likely lifelong posaconazole. Conclusion: This case augments the existing AIFS literature in that the histopathology uniquely demonstrates limited superficial invasion, underlying a fungal crust, likely portraying the early stages of AIFS. Additionally, this case highlights new and ongoing clinical questions surrounding AIFS prevention and diagnosis, particularly in immunocompromised patients.

KW - Alternaria

KW - Antifungal agents

KW - Invasive fungal infections

KW - Sinusitis

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Limited superficial invasion as an early manifestation of acute invasive fungal sinusitis

Abstract

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Keywords

ASJC Scopus subject areas

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