A Case of Fatal Penicillium Rhinosinusitis in a Patient With Acute Myelogenous Leukemia and Prolonged Neutropenia

Shah, Niel; Midha, Shonali; Nanjappa, Sowmya; Greene, John N.

doi:10.1097/ipc.0000000000000607

Cited by 3 publications

(9 citation statements)

References 18 publications

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“…In this study we noted that Fusarium, Aspergillus , Penicillium and Curvularia associated invasive rhinosinusitis with ocular symptoms had similar presentation and risk factors .Case reports from pre covid times suggest that all of them can be associated with invasive rhino sino orbital disease [ 3,[9][10][11]. Most of our patients had history of moderate covid disease, home treatment with no supplemental oxygen requirement and recent onset diabetes.…”

Section: Discussionsupporting

confidence: 53%

“…Magnetic resonance imaging (MRI) orbit, brain, and paranasal sinuses (PNS) with or without computed tomography (CT) was performed for assessing extent of the disease. High-resolution computed tomography thorax and COVID-19 reporting and data system (CORAD) score was used (RSNA consensus statement) to assess suspicion of chest involvement while CT severity score was used to categorize patients into mild (<8) moderate (9)(10)(11)(12)(13)(14)(15) and severe disease (>15) [4]. Deep seated tissue obtained with the help of deep nasal swab or sinus endoscopy was sent for KOH mount and fungal culture based on the clinical suspicion.…”

Section: Methodsmentioning

confidence: 99%

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Non Mucor Fungal Invasive Rhino Sinusitis with Ocular Signs in SARS Cov-2 Infection with Delta Variant (B.1.617.2) in India.

Ambasta

2022

Preprint

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Objective: To highlight fungi other than mucoromycetes as causative agent of invasive rhinosinusitis with ocular signs in recovered or concurrent covid 19 patients and identifying the presenting features, risk factors, intervention and outcomes.Method and analysis- Retrospective interventional study of seven patients with covid 19 who developed non mucor invasive rhinosinusitis with ocular involvement. Clinical presentation ,history and investigations analyzed. Management was by intravenous liposomal amphotericin B and functional endoscopic sinus surgery (FESS) with paranasal sinus debridement. Limited orbital debridement with or without transcutaneous retrobulbar liposomal amphotericin B(TRAMB) was done in patients with orbit involvement. Postoperative antifungal therapy was decided on basis of the causative fungi. Results- Four cases of Aspergillus and one each of Fusarium, Culvularia and Penicillium was seen .All patients had prominent periocular swelling and edema with pain and nasal stuffiness. Orbit involvement on MRI was seen in four cases: Partial third nerve palsy was seen in two and cavernous sinus thrombosis was seen in one with aspergillosis. Proptosis was not witnessed in any case. History of Diabetes and use of steroids was seen in all. All patients had mild to moderate covid with oxygen supplementation needed in one. No mortality , vision loss or exenteration happened. Conclusion: Secondary infection by Fungi other than mucoromycetes can be seen in covid 19. Timely surgical intervention and use of appropriate antifungals by correctly identifying causative fungi can lead to good prognosis.

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Section: Discussionsupporting

confidence: 53%

Section: Methodsmentioning

confidence: 99%

Non Mucor Fungal Invasive Rhino Sinusitis with Ocular Signs in SARS Cov-2 Infection with Delta Variant (B.1.617.2) in India.

Ambasta

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…In this study, we noted that Fusarium, Aspergillus, Penicillium, and Curvularia-associated rhinosinusitis with periocular swelling had similar presentations and risk factors. Case reports from pre-COVID times suggest that all of these can be associated with rhino-sino orbital disease [3,[9][10][11]. Most of our patients had a history of mild to moderate COVID-19 disease, home treatment with no supplemental oxygen requirement, and recent-onset diabetes.…”

Section: Discussionmentioning

confidence: 84%

“…Penicillium is a mold and is usually considered a contaminant or colonizer, which can occasionally cause a life-threatening infection [ 10 ]. Our patient had raised markers of inflammation with new-onset diabetes and was the only patient in our series to have lymphopenia at the time of presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) of the orbit, brain, and paranasal sinuses (PNS) with or without computed tomography (CT) was performed for assessing the extent of the disease. High-resolution computed tomography of the thorax and the COVID-19 reporting and data system score were used (RSNA consensus statement) to assess chest involvement, while the CT severity score was used to categorize patient disease as mild (<8), moderate (9)(10)(11)(12)(13)(14)(15), and severe (>15) [5]. Deep-seated tissue obtained with the help of a deep nasal swab or sinus endoscopy was sent for a KOH (potassium hydroxide) mount and fungal culture based on clinical suspicion.…”

Section: Methodsmentioning

confidence: 99%

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Non-Mucormycetes Causes of Fungal Rhino Sinusitis With Periocular Swelling in COVID-19 With Delta Variant

Ambasta¹,

Kusumesh²,

Rajpal³

et al. 2022

Cureus

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Objective: To highlight fungi other than mucormycetes as causative agents of rhinosinusitis with periocular swelling in coronavirus (COVID-19) infection caused by Delta variant of SARS-CoV-2 virus and identify the presenting features, risk factors, intervention, and outcomes.Methods and analysis: A retrospective interventional study of 96 patients with fungal rhinosinusitis and periocular swelling was done in patients with concurrent or recovered COVID-19 infection with the Delta variant (B.1.617.2) of SARS-CoV-2 virus in India. All patients with mucormycetes infection were excluded. Clinical presentation, medical history, blood reports, and imaging were analyzed. Management was by intravenous (IV) liposomal amphotericin B and functional endoscopic sinus surgery (FESS) with paranasal sinus debridement. Limited orbital debridement with or without transcutaneous retrobulbar liposomal amphotericin B (TRAMB) was done in patients with orbital involvement. Postoperative antifungal therapy was decided on the basis of the causative fungi.Results: Four cases of Aspergillus and one each of Fusarium, Curvularia, and Penicillium-associated fungal rhinosinusitis with periocular swelling were seen. Signs of orbital involvement on MRI were present in all four of them. Two of these showed partial third-nerve palsy while one case with aspergillosis suffered cavernous sinus thrombosis. Proptosis was not witnessed in any case. History of diabetes and use of steroids was seen in all patients. All patients had mild to moderate COVID-19 with oxygen supplementation needed in one. No mortality, acute vision loss, or exenteration took place. Conclusion: Aspergillus, Fusarium, Curvularia, and Penicillium were non-mucormycetes causes of fungal rhinosinusitis with periocular swelling in COVID-19 infection with the Delta variant (B.1.617.2) of SARS COV-2 virus. Few cases showed orbital and intracranial involvement.

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Invasive rhinosinusitis due toPenicillium chrysogenumin an adolescent man with new-onset leukaemia: a diagnostic dilemma

et al. 2022

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An adolescent boy with newly diagnosed T-cell acute lymphoblastic leukaemia developed right eye and facial pain, and a 1 cm × 2 cm area of black eschar over his hard palate. Initial differential diagnosis included rhinocerebral mucormycosis and aspergillosis, and he was started on liposomal amphotericin B. Later, he underwent nine surgical debridements of his sinus cavities, resection of a third of his palate and right orbital exenteration. While histological specimens exhibited features of bothAspergillusandMucor, a PCR assay detectedPenicillium chrysogenum. He was successfully treated with amphotericin B and Posaconazole.P. chrysogenumhas been reported in a rare case of endocarditis, a case of post-traumatic endophthalmitis, disseminated infection in a child with Henoch-Schonlein syndrome, and one fatal adult case of invasive rhinosinusitis. While infection fromPenicilliumspecies is rare, it should be considered as a cause of invasive rhinosinusitis in cases of unclear histopathology.

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A Case of Fatal Penicillium Rhinosinusitis in a Patient With Acute Myelogenous Leukemia and Prolonged Neutropenia

Cited by 3 publications

References 18 publications

Non Mucor Fungal Invasive Rhino Sinusitis with Ocular Signs in SARS Cov-2 Infection with Delta Variant (B.1.617.2) in India.

Non Mucor Fungal Invasive Rhino Sinusitis with Ocular Signs in SARS Cov-2 Infection with Delta Variant (B.1.617.2) in India.

Non-Mucormycetes Causes of Fungal Rhino Sinusitis With Periocular Swelling in COVID-19 With Delta Variant

Invasive rhinosinusitis due toPenicillium chrysogenumin an adolescent man with new-onset leukaemia: a diagnostic dilemma

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