Unusual presentations of isolated sphenoid fungal sinusitis

Abstract

Isolated sphenoid fungal sinusitis is a rare and often difficult to diagnose condition as the presenting symptoms are often vague and non-specific. In this series each case has a different clinical presentation with a different causative fungus. Although isolated fungal sphenoid sinusitis is usually seen in immunocompromised individuals, two of the three cases presented were immunocompetent. The fungi were Pseudallescheria boydii, Aspergillus fumigatus and Schizophyllum commune. In order to illustrate the great diversity of clinical signs, each case is individually presented. The characteristic radiological signs and the clinical management of each case are also presented. The danger signs of associated pathology are discussed with particular reference to an associated squamous carcinoma in one case. Surgical options and chemotherapy are discussed. Isolated sphenoid fungal sinusitis is a rare condition that if undiagnosed may result in considerable morbidity and even mortality of patients.

Scedosporium apiospermum: changing clinical spectrum of a therapy-refractory opportunist*

“…Predominant clinical findings are slight swelling of the face over the infected sinus, followed by nasal hypesthesia, pallor, and bleeding. The disorder is more common in arid climates [211]. Presence of fungus balls may lead to bone erosion due to pressure necrosis [212].…”

Molecular Characterization and In Vitro Antifungal Susceptibility Profile of Schizophyllum commune, an Emerging Basidiomycete in Bronchopulmonary Mycoses

“…Its surgical treatment alone is not adequate, and it must be combined with antifungal treatment (7). Furthermore, adjunctive antifungal therapy has been suggested to guard against the risk of dissemination or recurrence of the disease (8)(9)(10)(11). Despite the increasing clinical importance of S. commune, information on its molecular identification and antifungal susceptibility profile is scanty and limited to a small number or individual isolates (4,12).…”

“…Among the 29 globally reported cases of S. commune infection who had received antifungal therapy, there were 11 cases each with ABPM, 9 with sinusitis, 4 with bronchial mucoid impaction, and 1 case each with brain abscess, ulcer of the palate, fungal ball, bronchopneumonia, and pulmonary nodule (4,(7)(8)(9)(10). Of the 18 patients treated with itraconazole, all of them responded favorably without recurrence (4, 8-10, 19, 20, 24-31, 33-35).…”

Sphenoid sinus aspergilloma in trans-sphenoidal surgery for pituitary adenomas

“…Parker et al [26] and Shaw et al [31] in their report suggested the significant correlation between isolated fungal sinusitis and immunocompromised patients. Dubey et al [10] reported that diabetes mellitus (DM) was the most immunocompromising factor and present in 40 % of reported patients with CNS fungal infections.…”