title: An uncommon cause of allergic fungal sinusitis: Rhizopus oryzae.
abstract: We report what we believe is the first case of allergic fungal rhinosinusitis (AFRS) caused by the fungus Rhizopus oryzae. Our patient was a 32-year-old woman who presented with unilateral nasal polyps and chronic nasal dysfunction. Computed tomography of the sinuses detected left-sided pansinusitis and bone erosion. T2-weighted magnetic resonance imaging demonstrated a signal void that suggested the presence of a fungal infection. The patient underwent unilateral ethmoidectomy. Histologic examination of the diseased tissue identified allergic mucin with 70% eosinophils and no fungal hyphae. Mycologic culture detected R oryzae. After a short period of improvement, the patient experienced a recurrence, which was confirmed by radiology. A second surgery was performed, and the same fungal hyphae were found in the mucus and on culture, which led us to suspect AFRS. Since no IgE test for R oryzae was available, we developed a specific immunologic assay that confirmed the presence of specific IgG, which identified a high degree of immunologic reaction against our homemade R oryzae antigens. With a long course of systemic antifungal treatment, the patient's symptoms resolved and no recurrence was noted at 5 years of follow-up.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, HEGP, 20 Rue Leblanc, 75015 Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Devars du Mayne
authors.forename: Maxime
authors.initials: M
authors.lastname: Gratacap
authors.forename: David
authors.initials: D
authors.lastname: Malinvaud
authors.forename: Frederic
authors.initials: F
authors.lastname: Grenouillet
authors.forename: Pierre
authors.initials: P
authors.lastname: Bonfils
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D009091:Mucormycosis / Q000150:complications* / Q000382:microbiology; D009298:Nasal Polyps / Q000382:microbiology; D065631:Rhinitis, Allergic / Q000382:microbiology*; D012233:Rhizopus; D012852:Sinusitis / Q000382:microbiology*