We describe a case of noninvasive sinusitis caused by Paecilomyces lilacinus in a patient with diabetes mellitus. Cure was achieved by endoscopic drainage and aspiration of the fungal mass. We discuss the difficulty in and clinical importance of distinguishing Paecilomyces from Aspergillus, Pseudallescheria, a Zygomycete, or other molds.Empirical therapy for fungal infections continues to grow in paralysis of the left third cranial nerve. Three weeks before admission, the patient had noted an inability to open her left scope because of the increasing number of effective drugs that have become available and the increasing incidence and variety eye, which was accompanied by severe headaches and leftsided facial pain. A CT scan revealed a soft-tissue mass with of opportunistic fungal pathogens. Furthermore, until microbiological identification is provided, invasive fungal infections in an air fluid level in the left sphenoid sinus. The bone margins were intact (figure 1). She was transferred to our hospital for immunocompromised hosts must be dealt with in an urgent and expeditious manner by administering empirical antifungal further evaluation. On physical examination, the patient was unable to open her left eye, the left pupil was dilated, and therapy on the basis of clinical criteria.We describe a case of fungal sinusitis associated with ocular extraocular motion was severely limited. There was no erythema or swelling of the orbit, and no necrotic tissue was palsy in a patient with insulin-dependent diabetes mellitus. Fungal sinus infections in diabetics are often severe and may observed around the eye or buccal mucosa. Findings of the remainder of the physical examination were unremarkable. be disfiguring and even life-threatening when caused by a Zygomycete. Antifungal therapy differs for the many differentThe patient had received an empirical course of oral amoxifungi, and exenterative surgery may be required to cure some cillin/clavulanate as an outpatient, but her condition did not infections. A biopsy obtained at endoscopy of our patient's improve. She underwent endoscopic exploration and drainage sinus demonstrated numerous fungal elements without eviof the sphenoid sinus. The sinus epithelium was intact and dence of tissue invasion. On histological examination of the without erosion. The posterior aspect of the sinus was filled specimens, we could not determine with accuracy whether the by a mass. Microscopic examination of the biopsied mass and fungus was a Zygomycete, Aspergillus, Pseudallescheria, or a adjacent tissue showed entangled hyphae with moderately serepresentative of some other genus. There were features in the vere chronic and acute inflammation of the adjacent mucosa biopsy specimen compatible with several of the invasive and and submucosa; there was no evidence of oxalate crystals, more-often encountered fungi such as Aspergillus or a Zygowhich may occur with aspergillosis. There was no evidence of mycete. Paecilomyces lilacinus was subsequently cultured from tissue invasion. Dark flecks ...
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