Unusual rhinosinusitis caused by Curvularia fungi.
A variety of fungal diseases can affect the sinonasal cavities. Aspergillus fungus is the most common sole pathogen or copathogen, occurring in approximately 87% of cases. (1) Curvularia infection of the sinonasal area is rare.
We evaluated a 48-year-old black man who had a history of recurrent craniofacial dematiaceous infection of many years' duration. He had previously been evaluated at various institutions and treated with surgical debridement, irrigation, and antifungal therapy. He was suspected of having a natural-killer-cell deficiency. At presentation, he reported pain and exhibited a diffuse soft-tissue swelling of the sinonasal area. No evidence of infection in other organs was noted.
Computed tomography (CT) of the sinonasal area revealed extensive bone destruction in the maxillary and nasal cavities secondary to chronic infection with osteomyelitis (figure 1). Magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. (MRI) demonstrated diffuse inflammatory soft tissues in the facial and sinonasal areas (figure 2). Histologic findings and culture analysis identified a mycotic mycotic /my·cot·ic/ (mi-kot´ik)
1. pertaining to mycosis.
2. caused by a fungus.
1. Relating to mycosis.
2. infection secondary to Curvularia invasion.
[FIGURES 1-2 OMITTED]
Curvularia is a prevalent member of the Dematiaceae family of the Hyphomycetes class of fungi. These fungi contain melanin in their hyphae hy·pha
n. pl. hy·phae
Any of the threadlike filaments forming the mycelium of a fungus.
[New Latin, from Greek huph . (1) Several Curvularia species are zoopathologic. Recently, reports have surfaced that saprobic sap·robe
An organism that derives its nourishment from nonliving or decaying organic matter.
[sapro- + Greek bios, life; see gwei- in Indo-European roots. fungi, as well as fungi pathogenic for plants, have evolved as human pathogens; reported cases have involved skin infections, endocarditis, brain abscess, onychomycosis, keratitis keratitis
Inflammation of the cornea (see eye). The conjunctiva may also be inflamed (keratoconjunctivitis). Depending on the cause, including dryness of the eye (from low tear production or inability to close the eye), chemical or physical injury, or certain , mycetoma Mycetoma Definition
Mycetoma, or maduromycosis, is a slow-growing bacterial or fungal infection focused in one area of the body, usually the foot. , bronchopulmonary bronchopulmonary /bron·cho·pul·mo·nary/ (-pool´mah-nar?e) pertaining to the bronchi and the lungs.
Relating to the bronchial tubes and the lungs. disease, and rhinosinusitis. (2-4) Although most of these infections occurred in immunocompromised patients, other patients appeared to be immunocompetent im·mu·no·com·pe·tent
Having the normal bodily capacity to develop an immune response following exposure to an antigen.
im , as was our patient.
(1.) Wilhelmus KR, Jones DB. Curvularia keratitis. Trans Am Ophthalmol Soc 2001:99:111-30: discussion 130-2.
(2.) Nishioka G, Schwartz JG, Rinaldi MG, et al. Fungal maxillary sinusitis caused by Curvularia lunata. Arch Otolaryngol Head Neck Surg 1987; 113:665-6.
(3.) Ebright JR, Chandrasekar PH, Marks S, et al. Invasive sinusitis and cerebritis due to Curvularia clavata in an immunocompetent adult. Clin Infect Dis 1999;28:687-9.
(4.) Schell WA. Unusual fungal pathogens in fungal rhinosinusitis. Otolaryngol Clin North Am 2000,33:367-73.
From the Department of Radiology, Louisiana State University Health Sciences Center, New Orleans.