Fungus ball sinusitis due to Fusarium proliferatum. Report of a case and review of the literature

D.C. Damiani, T. Chouaki, B. Guichard, Y. El Samad, S. Sid Idris, S. Blanpain, S. Testelin, C. Hennequin

Author address: 

CHU D'Amiens, AMIENS, France

Abstract: 

Fungus balls are the predominant clinical form of non-invasive sinusitis. Typically, they occur in immunocompetent patients with an unilateral involvement of a maxillary sinus, Aspergillus fumigatus being the most frequent etiologic agent. We report the clinical case of a 47-year old immunocompetent female who was diagnosed with a left maxillary sinusitis due to F. proliferatum. Four years ago she had received a root canal therapy. CT-scan showed a granulomatous and heterogeneous thickness of the mucosa organized around a foreign body. Fusarium was demonstrated in the direct microscopic examination and isolated in heavy growth from the materials collected during a Caldwell-Luc operation. Morphologic characteristics and TEF1 gene sequence identified the strain as F. proliferatum. In vitro susceptibility testing (EUCAST method performed at the Centre National de Rí©fí©rence des Mycoses et des Antifongiques, Pasteur Institute, Paris) revealed high MIC against amphotericin B (≥ 8 μg/ml), Flucytosine (≥ 64 μg/ml), Voriconazole (8 μg/ml), Itraconazole (≥ 8 μg/ml) and Caspofungin (≥ 8 μg/ml ). The patient was successfully treated with oral ketoconazole (200 mg/day) for two weeks. Review of the literature reveals 6 additional cases of Fusarium sinusitis. Two immunocmpromised patients died with an uncontrolled infection. Characteristics imaging features and direct examination demonstrating fungal elements associated with negative cultures are common features of fungal sinusitis. However, identification of the etiologic agent is important for therapeutic adaptation. New antifungal agents should be tested as they could represented alternative therapeutic strategies.
2009

abstract No: 

P111

Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)