A fatal case of necrotizing sinusitis due to toxigenic Corynebacterium ulcerans.
A 77-year-old farmer developed cough with sputum production, fever, bloody nasal discharge and a mass in his right maxillary sinus leading to necrotic ulceration of the sinus. Corynebacterium ulcerans, carrying the beta-phage for the diphtheria toxin and secreting the toxin, was detected microscopically and by culture from the sinusoidal and ulcer discharge. Despite immediate antimicrobial chemotherapy the patient died of pulmonary failure associated with the production of large amounts of very viscous sputum. Identification of the causative agent, pathophysiological aspects and risk factors of this unusal infection are discussed.
Department of Medical Microbiology and Hygiene, University of Ulm, Germany. nele.wellinghausen@medizin.uni-ulm.de
Nele
N
Wellinghausen
Andreas
A
Sing
Winfried V
WV
Kern
Sven
S
Perner
Reinhard
R
Marre
Jochen
J
Rentschler
D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003352:Corynebacterium / Q000235:genetics / Q000472:pathogenicity*; D003354:Corynebacterium Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D004167:Diphtheria Toxin / Q000235:genetics; D017809:Fatal Outcome; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008297:Male; D015523:Maxillary Sinusitis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D009336:Necrosis; D015242:Ofloxacin / Q000627:therapeutic use; D010446:Peptide Fragments / Q000235:genetics
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D004167:Diphtheria Toxin; D010446:Peptide Fragments; C029795:diphtheria toxin fragment A; D015378:Imipenem; D019980:Amoxicillin-Potassium Clavulanate Combination; D015242:Ofloxacin