PresentationA 71-year-old male presents to the Emergency Department (ED) with 4 months of headaches and radiating pain on the right side of his face. The patient has a history of sinusitis and was taking antibiotics for 6 months without any resolution of his symptoms. Surgery was performed 2 months prior to this admission which resulted in the removal of a fungus ball from his sinus cavity. The patient was treated with corticosteroids at the time of the surgery. Upon presentation in the ED, he was admitted to the hospital for further evaluation.
Lab TestingBased on the clinical presentation of the patient and the prior removal of the fungus ball 2 months ago, a biopsy of the sinus tissue was taken and sent to the microbiology laboratory for Fungal Culture. Special stains for fungal elements were also performed on the tissue. The culture grew Scedosporium apiospermum and the tissue stain showed septate hyphae with acute angle branching.
Cause of SymptomsEnvironmental fungi can cause a common infection called Allergic Fungal Rhinosinusitis (AFR) in the sinus tract resulting in an allergic reaction with the production of mucus subsequently blocking the sinuses. Progression to invasive disease is rare, especially in immunocompetent patients but can be triggered by corticosteroid use. There are several fungi that can cause AFR.
TreatmentTreatment can vary depending the fungus isolated but typical treatment for S. apiospermum is Voriconazole. A susceptibility test was performed on this patients’ isolate and found to be susceptible with an MIC to Voriconazole of 1 µg/ml.
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