Gupta Nitin, Kumar Arvind, Singh Gagandeep, Ratnakar Gogineni, Vinod Kutty Sharada, Wig Naveet
Departments of Medicine and Microbiology, All India Institute of Medical Sciences.
Department of Medicine, All India Institute of Medical Sciences.
Drug Discov Ther. 2017;11(6):349-352. doi: 10.5582/ddt.2017.01060.
Invasive fungal rhinosinusitis (FRS) is a potentially fatal illness requiring early diagnosis and aggressive treatment with surgery and antifungals. We report a case of chronic FRS in a recently diagnosed diabetic individual due to Curvularia lunata. Imaging revealed extension into the right orbit and right basifrontal lobe. This was further complicated by development of nosocomial mucormycosis which was attributed to voriconazole therapy. The patient responded well to debridement and amphotericin B based therapy. To our knowledge, there are no reported cases of invasive FRS due to Curvularia lunata. Also, breakthrough mucormycosis on voriconazole therapy is rarely seen in non-malignancy, non-transplant settings. The possibility of rare fungal infections (community and nosocomial) should be entertained in developing settings where fungal spores are ubiquitous.
侵袭性真菌性鼻-鼻窦炎（FRS）是一种潜在的致命疾病，需要早期诊断并通过手术和抗真菌药物进行积极治疗。我们报告一例近期诊断为糖尿病的患者因新月弯孢霉引起的慢性FRS病例。影像学检查显示病变已蔓延至右侧眼眶和右侧额叶底部。该病例因伏立康唑治疗引发医院获得性毛霉病而使病情更加复杂。患者对清创术和基于两性霉素B的治疗反应良好。据我们所知，尚无新月弯孢霉引起侵袭性FRS的病例报道。此外，在非恶性肿瘤、非移植环境中，伏立康唑治疗期间出现突破性毛霉病的情况也很少见。在真菌孢子无处不在的发展中地区，应考虑罕见真菌感染（社区感染和医院获得性感染）的可能性。
