Acute invasive rhinosinusitis case caused by Aspergillus flavus in two patients prediagnosed with mucormycosis

Abstract

Acute invasive rhinosinusitis caused by Aspergillus spp. may lead to invasive disease and mortality, especially in immunocompromised individuals. In this report, two invasive fungal rhinosinusitis cases in an immune compromised patient have been presented that were pre-diagnosed with mucormycosis, but with a positive culture for Aspergillus flavus. Twenty-four years old male patient with aplastic anemia and seven years old patient with acute lymphoblastic leukemia; facial pain, edema, and necrotic lesions developed in both cases. Tissue samples were obtained from lesions through the nose by biopsy for definitive diagnosis. Septate fungal hyphae observed on the microscopic examination of the specimen, and A. flavus was isolated in the culture in both cases. Surgical debridement could not be performed because of patients’ general conditions. Despite antifungal therapy and treatments, patients died. Delay in diagnosis and treatment may lead to high mortality rates. These cases emphasize the importance of diagnosis with culture. J Microbiol Infect Dis 2015;5(3): 137-141

Key words: Acute invasive fungal rhinosinusitis, Aspergillus flavus, diagnosis.

Keywords

• Acute invasive fungal rhinosinusitis, Aspergillus flavus, diagnosis

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Öz

Aspergillus türlerinin neden olduğu akut invaziv fungal rinosinüzit; immünsüprese hastalarda mortaliteye yol açabilir.Rinoserebral mukormikoza klinik olarak benzediğinden mukormikoz ön tanısı almış ancak kültürde etken olarak Aspergillus flavus üretilmiş iki invaziv fungal rinosinüzit olgusu bu raporda sunulmuştur. Aplastik anemi tanısıyla takip edilen 24 yaşındaki erkek hasta ve akut lenfoblastik lösemi tanısıyla izlenen yedi yaşındaki kız çocuğunda yüzde ağrı, ödem, ve burun çevresinde nekrotik lezyonlar mevcuttu. Antifungal tedaviye rağmen burunda nekroz gelişti. Tanı amacıyla burundaki lezyondan alınan biyopsi örneğinin mikroskobik incelemesinde septalı hifler görüldü ve kültürde iki olguda da A. flavus izole edildi. İki olgumuzda da gerekli tedaviler yapılmış olup cerrahi debridman hastaların genel durum bozukluğu nedeniyle yapılamadı ve antifungal tedaviye rağmen hastalar kaybedildi. İnvaziv fungal enfeksiyonlarda erken tanı ve tedavi hayati önem taşımaktadır. Bu olgular, fungal enfeksiyonların tanısında ve tedaviyi doğru şekilde yönlendirebilmede kültürün önemini vurgulaması açısından önemlidir

Anahtar Kelimeler

• Akut invaziv fungal rinosinüzit, Aspergillus flavus, tanı

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