Allergic fungal sinusitis caused by Bipolaris (Drechslera) hawaiiensis

被引:18
作者
Fryen, A
Mayser, P
Glanz, H
Füssle, R
Breithaupt, H
de Hoog, GS
机构
[1] Univ Giessen, Dept ENT, D-35392 Giessen, Germany
[2] Univ Giessen, Dept Dermatol & Androl, D-35392 Giessen, Germany
[3] Univ Giessen, Dept Microbiol, Giessen, Germany
[4] Univ Giessen, Dept Internal Med, Giessen, Germany
[5] Cent Bur Schimmelcultures, NL-3740 AG Baarn, Netherlands
关键词
mycotic polypoid pansinusitis; Bipolaris (Drechslera) hawaiiensis; infection; endoscopic microsurgical pansinus surgery antimycotic therapy;
D O I
10.1007/s004050050157
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Depending on the aggressiveness of the pathogen and a patient's immunocompetence, fungal polypoid pansinusitis or allergic fungal sinusitis (AFS) may be a life-threatening disease. Apart from the clinical findings, its diagnosis is based on the demonstration of mucinous material with abundant eosinophils in the paranasal sinuses (indicating an allergic process), cultivation of the causative pathogen and immunocompetence of the patient. In a 20-year-old immigrant Sudanese woman, AFS due to Bipolar-is (Drechslera ) hawaiiensis was diagnosed. Because of intracranial extension, the disease had led to erosion of the cranial base and orbit with amaurosis on the right side and focal epilepsy. In addition to endonasal microsurgical pansinus operations, local irrigation therapy with amphothericin B was accompanied by systemic treatment with itraconazole after in vitro cultivation of the pathogen and determination of its sensitivities. Interdisciplinary management included a combination of endonasal surgery with debridement of infected tissues and wide drainage of the sinuses without removal of skull bone or the dural lesion in addition to specific antimycotic treatment. Injury to adjacent anatomical structures must be avoided in any case to prevent systemic or possibly lethal dissemination of infection.
引用
收藏
页码:330 / 334
页数:5
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