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 (MRI) demonstrated diffuse inflammatory soft tissues in the facial and sinonasal areas (figure 2). Histologic findings and culture analysis identified a mycotic 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. (1) Several Curvularia species are zoopathologic. Recently, reports have surfaced that saprobic fungi, as well as fungi pathogenic for plants, have evolved as human pathogens; reported cases have involved skin infections, endocarditis, brain abscess, onychomycosis, keratitis, mycetoma, bronchopulmonary disease, and rhinosinusitis. (2-4) Although most of these infections occurred in immunocompromised patients, other patients appeared to be immunocompetent, as was our patient.

References

(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.