Wang Yuting, Liu Qingzhong, Sheng Huiming, Yang Shuohui
Department of Clinical Laboratory Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Clinical Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Am J Case Rep. 2025 Apr 8;26:e946501. doi: 10.12659/AJCR.946501.
BACKGROUND Acremonium strictum (A. strictum) is an opportunistic fungus that is a rare environmental and saprophytic pathogen. Because of its rarity and inadequate mastery of clinicians, A. strictum sphenoid sinusitis becomes a refractory disease in some immunocompetent patients. Moreover, its etiologic and radiological diagnoses are challenging, leading to inappropriate treatment and a protracted course. CASE REPORT We report a case of A. strictum sphenoid sinusitis in an immunocompetent 74-year-old female patient. She had dizziness and head distension accompanied by intermittent vomiting for 3 months. Computed tomography (CT) suggested a chronic noninvasive fungal sphenoid sinusitis. She underwent a resection of the lesion and postoperative anti-infection therapy. Two months later, the lesions reappeared and were confirmed by CT again. Microbiological culture of purulent tissue revealed a growth of filamentous fungus identified as A. strictum by 26S rRNA sequencing. After 4 weeks of oral voriconazole treatment, the patient recovered and had not relapsed at 2-year follow-up. CONCLUSIONS The rare occurrence of A. strictum as a causative agent of sphenoid sinusitis underscores the importance of utilizing radiological imaging, microbiological culture, and molecular diagnostic techniques to enhance diagnostic accuracy. This case emphasizes the need for heightened clinical suspicion and targeted antifungal therapy to manage fungal infections effectively.
绳状枝顶孢霉是一种机会性真菌，是一种罕见的环境和腐生性病原体。由于其罕见性以及临床医生对此掌握不足，绳状枝顶孢霉引起的蝶窦炎在一些免疫功能正常的患者中成为难治性疾病。此外，其病因学和影像学诊断具有挑战性，导致治疗不当和病程迁延。病例报告：我们报告一例74岁免疫功能正常的女性患者发生绳状枝顶孢霉蝶窦炎的病例。她头晕、头胀并伴有间歇性呕吐3个月。计算机断层扫描（CT）提示慢性非侵袭性真菌性蝶窦炎。她接受了病变切除术及术后抗感染治疗。两个月后，病变复发，CT再次证实。脓性组织的微生物培养显示丝状真菌生长，经26S rRNA测序鉴定为绳状枝顶孢霉。口服伏立康唑治疗4周后，患者康复，在2年随访中未复发。结论：绳状枝顶孢霉作为蝶窦炎病原体的罕见出现凸显了利用放射影像学、微生物培养和分子诊断技术提高诊断准确性的重要性。该病例强调了提高临床怀疑度和针对性抗真菌治疗以有效管理真菌感染的必要性。
