Invasive sinonasal disease due to Scopulariopsis candida: case report and review of scopulariopsosis.
Sinonasal infection with fungi of the order Mucorales--termed mucormycosis or zygomycosis--is sometimes seen in immunosuppressed patients, including those with diabetic ketoacidosis and malignancy. We describe a case of invasive sinonasal infection with Scopulariopsis candida (not among the Mucorales organisms) in a 12-year-old girl who was being treated for non-Hodgkin's lymphoma. Only a few cases of invasive infection with Scopulariopsis species have been reported previously; five of six of these cases were associated with persistent or fatal disease. Our patient survived without undergoing radical surgical debridement and was treated with granulocyte colony-stimulating factor, amphotericin B, and itraconazole; chemotherapy was stopped. In vitro susceptibility testing of our patient's Scopulariopsis isolate showed that it was resistant to amphotericin B and that it was relatively susceptible to itraconazole and miconazole. The case described herein demonstrates the expanding spectrum of fungal organisms that may cause invasive sinonasal infection in immunocompromised hosts and the need for reliable antifungal susceptibility testing.
Kriesel
J D
JD
Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City 84132.
Adderson
E E
EE
Gooch
W M
WM
Pavia
A T
AT
D000666:Amphotericin B / Q000627:therapeutic use; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008443:Maxillary Sinus / Q000382:microbiology; D003904:Mitosporic Fungi / Q000254:growth & development / Q000302:isolation & purification*; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy; D010254:Paranasal Sinus Diseases / Q000188:drug therapy / Q000382:microbiology*
D016179:Granulocyte Colony-Stimulating Factor; D017964:Itraconazole; D000666:Amphotericin B