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

Abstract

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.