Background

The prevalence of pulmonary aspergillosis and the importance of its early diagnosis are recognized. However, non-pulmonary involvement, including the sinuses region, is not frequently reported, and an infection in this area can affect all paranasal sinuses (pansinusopathy), being a rare pathology that affects immunocompromised hosts. Recent studies have highlighted the occurrence of Aspergillus flavus resistant to antifungal therapy. Therefore, a nasal sinus infection by resistant Aspergillus strains in immunocompromised patients may be linked to a high risk of lethality.

Case report

We are reporting a resistant A. flavus infection in an allogeneic hematopoietic stem cell transplant recipient with episodes of febrile neutropenia, and prolonged use of various antibacterial drugs and antifungal prophylaxis. The patient underwent brain magnetic resonance, which showed the presence of pansinusopathy, and presented necrosis in the left nasal region. Direct microscopic examination of a sample taken from the nasal mucosa revealed the presence of septate hyphae and conidiophores resembling those of A. flavus, that species being the identification achieved with MALDI-TOF MS. Antifungigram was performed by microdilution in broth (EUCAST-E.DEF. 9.3.2) and E-test, and resistance to amphotericin B was shown in both tests. The patient died after septic shock and hemorrhage.

Conclusions

Invasive fungal infections due to amphotericin-B resistant A. flavus may lead to the death of the patient due to an ineffective therapeutic management. Therefore, antifungal susceptibility testing are of utmost importance for administering the proper treatment.

中文翻译：

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两性霉素 B 抗性黄曲霉致死性破坏性鼻窦病：病例报告

背景

肺曲霉病的流行及其早期诊断的重要性已得到认可。然而，包括鼻窦区域在内的非肺部受累并不经常报道，并且该区域的感染可影响所有鼻窦（全鼻窦病），这是一种影响免疫功能低下宿主的罕见病理。最近的研究强调了黄曲霉抗真菌治疗的发生。因此，在免疫功能低下的患者中，由耐药曲霉菌株引起的鼻窦感染可能与高致死风险有关。

案例报告

我们正在报告一位同种异体造血干细胞移植受者出现耐药性黄曲霉感染，并出现发热性中性粒细胞减少症，并长期使用各种抗菌药物和预防性抗真菌药物。患者接受了脑磁共振检查，结果显示存在全鼻窦病变，并在左侧鼻区出现坏死。对取自鼻粘膜的样本进行直接显微镜检查，发现存在类似于黄曲霉的有隔膜菌丝和分生孢子，该物种是通过 MALDI-TOF MS 实现的鉴定。通过在肉汤中微量稀释 (EUCAST-E.DEF. 9.3.2) 和 E-test 进行抗真菌检查，并且在两个测试中都显示出对两性霉素 B 的抗性。患者在感染性休克和出血后死亡。

结论

由抗两性霉素 B黄曲霉引起的侵袭性真菌感染可能会因治疗管理无效而导致患者死亡。因此，抗真菌药敏试验对于进行适当的治疗至关重要。