Fungal septal abscess complicating maxillary sinus fungus balls in an immunocompetent host.
Fungal septal abscess complicating maxillary sinus fungus balls in an immunocompetent host.
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DOI：
10.2500/ar.2015.6.0139
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发表时间：
2015-01
期刊：
影响因子：
--
通讯作者：
Orlandi RR
中科院分区：
文献类型：
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作者：
Patel R;Orlandi RR
鼻腔真菌感染可以是破坏性的实体，通常见于免疫受损的宿主。我们报告一例上颌窦真菌球内窥镜治疗后，免疫功能正常的宿主出现局限性鼻中隔真菌脓肿的病例。一位51岁女性，有哮喘史，最近接受口服类固醇治疗，出现双侧上颌窦真菌瘤。她接受了内窥镜鼻窦手术。术后病程因哮喘发作而复杂化，需要口服类固醇。患者返回时出现鼻塞，体检结果与鼻中隔脓肿相符。尝试了引流，培养出了真菌成分。脓肿再次聚集，病人被转诊到我们机构。手术引流是通过在间隔脓肿腔内放置导管来完成的。通过这个场地进行了48小时的两性霉素灌溉。患者开始接受口服抗真菌治疗。免疫检查的结果是阴性的，包括人类免疫缺陷病毒检测和免疫球蛋白水平评估。最终培养的真菌培养物生长出对伏立康唑敏感的顶生塞多孢菌。患者完成了治疗，没有进一步复发。术后6个月随访，未见真菌性中隔感染复发。鼻窦真菌感染很少发生在免疫能力强的宿主中。鼻中隔可能是在内窥镜鼻窦手术中植入的。口服类固醇的使用可能是该患者发生侵袭性鼻中隔真菌脓肿的危险因素。这是第一例报告的鼻中隔脓肿的其他免疫活性宿主的无菌葡萄球菌。
Fungal infections of the nasal cavity can be destructive entities that are typically seen in immunocompromised hosts. We present a case of a localized fungal abscess of the nasal septum in an immunocompetent host after endoscopic treatment of maxillary sinus fungus balls. A 51-year-old woman with a history of asthma and recent treatment with oral steroids presented with bilateral maxillary sinus mycetomas. She underwent endoscopic sinus surgery. The postoperative course was complicated by an asthma flare, which required oral steroids. The patient returned with nasal obstruction, and results of a physical examination were consistent with a nasal septal abscess. Drainage was attempted, and cultures showed fungal elements. The abscess reaccumulated, and the patient was referred to our institution. Operative drainage was performed with placement of a catheter in the septal abscess cavity. Forty-eight hours of amphotericin irrigations were performed through this site. The patient was started on oral antifungal therapy. Results of an immune workup, including testing for human immunodeficiency virus and assessing immunoglobulin levels, were negative. Final fungal cultures grew Scedosporium apiospermum sensitive to voriconazole. The patient completed therapy without further recurrence. Follow-up at 6 months demonstrated no further recurrence of her fungal septal infection. Sinonasal fungal infections rarely occur in immunocompetent hosts. The septum may have been seeded during the endoscopic sinus surgery. The use of oral steroids may have been a risk factor for the development of an aggressive nasal septal fungal abscess in this patient. This is the first reported case of a nasal septal abscess in an otherwise immunocompetent host with S. apiospermum.