Schizophyllum commune allergic fungal rhinosinusitis with sellar propagation and hyperprolactinemia in immunocompetent man - histology and mycology findings

V. Arsic Arsenijevic1, S. Pekic2, M. Skender Gazibara3, A. Dzamic1, E. Ratkov1, V. Popovic2

Author address: 

1Institute of Microbiology and Immunology, BELGRADE, Serbia 2Institute of Endocrinology University Clinical Center, BELGRADE, Serbia 3University of Belgrade, BELGRADE, Serbia

Abstract: 

Allergic fungal rhinosinusitis (AFRS) represents a hypersensitivity response in the sinus cavity usually caused with Aspergillus, Culvularia, Bipolaris or zygomycetes. Only in few cases Schizophyllum commune was reported manly because of difficultly to detect them with conventional mycological examinations. In rare case intracranial propagation of AFRS has been reported and these lesions may be mistaken for pituitary tumors. Objectives: We describe the histology and mycology findings of S. commune AFRS followed by massive sellar propagation hyperprolactinemia and diplopia. A 44-year-old immunocompetent male presented with symptoms of nasal obstruction, diplopia and headache. Endocrinological evaluation of the pituitary function revealed normal pituitary function and hyperprolactinemia. The patient underwent transnasal transsphenoidal operation and the functional endoscopic sinus surgery. Methods: Histology examination of formalin-fixed and paraffin-embedded tissue and mucin sample were performed staining by Hematoxylin and eosin (H&E) and Gomoris methenamine silver (GMS). For mycology examination the tissue was homogenized for direct Blankofor smear preparation and culturing. Sabouraud dextrose agar plates were incubated on 28°C and 37°C and followed daily for fungal growth. Subcultivation was done on Potato dextrose and Chapek agar. Results: Histologicaly pituitary gland adenoma was not detected but revealed clusters of eosinophilic granulocytes (H&E) and septate fungal hyphae within the allergic mucin (GMS). The hyphae seemed to be impacted or embedded within the clusters of eosinophils, proliferates as septate hyphae 2.5-4.5 μm in diameter with characteristic branching dichotomy (approximately 45°C angle), suggesting Aspergillus infection but a fungal invasion of the tissue was not observed. Tissue Blankophor staining revealed hyphae and on the plate the growing was observed after 3 days on both temperatures as white cottony mold colony with a yellow reverse and strong and disagreeable smell, reaching a diameter of 4 cm in 7 days labeled as "œsterile mycelium". Subcultivation on Potato dextrose and Chapek agar microscopically demonstrated hyphae with clamp connections and fruiting bodies suggesting S. commune. Identity of fungal strain was confirmed by sequencing analyze in the Centraalbuerau voor Schimmelcultures, Utrecht, The Nitherlands. Conclusion: This is the first case of AFRS caused by S. commune in immunocompetent patient, complicated with formation of the large pseudotumor and its propagation to the sellar region followed with hyperprolactinemia and diplopia documented by histology, mycology and strain sequencing analyze. It is likely that AFRS caused by S. commune is not rear but are usually misdiagnosed or not recognized because of the lack familiarity of doctors with this fungus.
2009

abstract No: 

P056

Full conference title: 

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